Healthcare Customer Service Advocate
HybridMakati City, Metro Manila, Philippines or Makati, Cagayan Valley, Republic of the Philippines
Job Summary
Serve as a primary point of contact for healthcare providers and billing representatives regarding eligibility, claims, payments, appeals, and EOBs inquiries. Handle assigned interactions via phone, email, fax, and web channels while accurately researching systems and resolving issues within your established scope. Document every interaction in appropriate systems, follow required workflows without deviation, and escalate matters outside your authorized scope. Maintain a zero-error mindset by adhering to strict quality standards, completing QA monitoring, and addressing performance gaps through coaching and corrective actions. Successfully complete all required training, assessments, nesting, and certification before becoming eligible for remote work. Work night or graveyard shifts onsite for the first six months, then transition to remote based on performance.
Required Qualifications
- High school diploma or equivalent
- College degree or relevant post-secondary education
- At least 4 years of experience in a healthcare contact center, provider services, claims support, or comparable healthcare operations environment
- Working knowledge of healthcare claims, EOBs, appeals, eligibility, benefits, and payment processes
- Ability to research and interpret claim and provider information accurately
- Strong analytical, problem-solving, multitasking, organizational, verbal, and written communication skills
- Strong attention to detail and demonstrated commitment to accuracy
- Ability to work in a metrics-driven environment and consistently meet established productivity and quality requirements
- Proficiency with Microsoft Office and online systems
- Ability to learn and navigate multiple healthcare and client systems
- Ability to work flexible schedules, including nights, weekends, and holidays, based on client coverage requirements
- Must successfully complete all required training, assessments, certification, nesting, and graduation requirements before becoming eligible to work remotely
- Must be able to lift 50 lbs
Desired Qualifications
- College degree or relevant post-secondary education
- Experience with Monday.com and AWS Connect
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