Specialist-MCC

DUTIES & RESPONSIBILITIES:

• CSAs will answer and resolve inbound telephone calls pertaining to medical products and services about benefit, claim or eligibility and non- clinical Utilization Management issues from a Doctor/Hospital regarding (1) one or more issues about a single Customer, or (2) one or more issues about multiple Customers.
• CSAs will transfer to Company calls pertaining to Company’s products and services other than medical.
• CSAs may be engaged to support the centralized fax administration process to complete necessary research and document production to send an outgoing fax to resolve an inbound inquiry to the customer’s satisfaction.
• Authenticate both the Customer and the Healthcare Professional’s information by means of asking information that should match what is listed in the system.
• Capture all relevant information that transpired in the call and properly document it in the client’s system.
• Protect and secure member’s Protected Health Information (PHI).
• Utilize existing resources to provide resolution to healthcare professional’s concern.
• Maintain professionalism and positive working relationships with team members, internal customers, and external customers.
• Validates and organizes the information received.
• Makes sure that the data received is available to appropriate people and systems within the organization.
• Participate on the online training set by US counterpart for updates.

General Safety and Security

• Protects the organization’s assets by upholding the principles of the Quality Information Security Management System (QISMS).
• Ensures confidentiality, integrity, and availability of information critical to fulfilling the organization’s business functions.
• Remain compliant with the relevant business, local and international regulatory and legislative requirements particularly the Health Insurance Portability and Accountability Act of 1996 (HIPAA), HITECH Act and URAC

COMPETENCY REQUIREMENTS:

With Basic Competency Level in the ff.:

Excellent interpersonal skills Ability to understand and interpret policy provisions.  Product knowledge Typing Skills Problem Solving Skills

With Moderate Competency Level in the ff.:

US Healthcare Delivery System Philippine Healthcare Delivery System US Healthcare 101 See Attached Customer Experience Checklist Customer Service orientation Computer literate Interpersonal Skills Sense of Urgency Passion for Excellence

OTHER REQUIREMENTS:

Reports to: 

Team Leader

Education and/or Experience:

• Graduate of any 4-yr College Degree; or
• Completed at least 2 years in College with minimum 6 months BPO or Customer Service Experience.
• Preferably with 1 – 2 years of Customer Service experience.

Certificates, Licenses, Registrations:

• N/A

Work environment:

The work environment is professional, office. Business casual attire.

Physical demands:

May require weekend, evening or shifting work schedule.

Work demands:   

Complete Customer Service Associate training program and achieve certification.