Customer Service Representative (Healthcare | Day 1 HMO)

Receive inbound calls from members who are enrolled US healthcare insurance members. Assist beneficiaries with a wide range of critical services, which include but not limited to updating account information, providing plan information, resolving issues with utilization of the plan. Place outbound calls as directed and necessary for member resolution.

BASIC QUALIFICATIONS:

• College graduate with at least 1-year BPO experience (preferred but not required)
• 2nd year undergraduate (completed level) with at least 1-year BPO experience
• With excellent English communication skills
• Amenable to work onsite at Mandaluyong City
• Amenable to work at night

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Update account information such as billing options and changes of address or phone numbers.
• Research premium billing discrepancies and prescription claims processed.
• Educate beneficiaries on how the plan works, including benefits, cost sharing, and levels of coverage.
• Submit mail requests for beneficiaries such as ID cards and formularies.
• Look up medicines on the formulary to verify if they are covered, the tier and copay level, and if a drug is not covered, provide an explanation as to why.
• Displays positive demeanor, technical accuracy, and conformity to company policies.
• Understands CMS Guidance and ensures applicable Exhibits are being mailed per CMS Guidance.
• Ensure HIPAA regulations are maintained within the immediate environment.
• Responsible for concise and detailed notations as it pertains to member records.
• Handles outbound calls for purposes of validating information.
• Handles inbound calls by assisting members with a high level of accuracy and efficiency.
• Escalates any member issues to management as necessary.
• Responsible for maintaining a high level of call quality as set by client standards, which includes a 95% quality score, and answering 80-85% of calls within 30sec or less
• Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner.
• Conform with and abide by all regulations, policies, work procedures and instructions.
• Respond promptly when returning telephone calls and replying to correspondence and faxes.
• Act, dress, and behave in a professional manner to reflect a positive image of the company.

BENEFITS:

• Day 1 HMO and 2 free dependents upon regularization
• Life insurance
• PTO credits

WHO WE ARE

Convey Health Solutions manages a myriad of administrative needs and make it easier for health plans to operate and provide valuable experiences for their members. How so? We focus on building specific technologies and services that uniquely meet the needs of government-sponsored health plans.

OUR MISSION
To improve health plan operations and elevate the customer experience.

OUR VISION

Empowering health plans to excel through technology, service and advisory experience.

OUR VALUES

Integrity First - Inspired Teamwork - Compliance Matters