Healthcare Customer Service Representative

Healthcare Customer Service Advocate Work Setup: Onsite (with possibility of Hybrid work depending on performance, attendance, and business needs) Location: Insular Life, Makati Work Schedule: 5 days per week, graveyard shift (shifting schedule with possible weekend work) Job Summary: As a Healthcare Customer Service Advocate , you will support U.S. healthcare members by handling benefits inquiries, eligibility verification, and medical claims processing. This role requires strong healthcare knowledge, urgency, and accuracy in a high-volume BPO environment. Key Responsibilities: Customer Support: Answer inbound calls and chats from our customers to include but not limited to providers, health plans, insurance brokers, and hospitals in accordance with HIPAA guidelines. Provide accurate and up-to-date information about coverage plans, including eligibility, benefits, limitations, and exclusions. Coordinates complete resolution of service issues by interfacing with other departments including Eligibility, Benefits, Claims and any other departments internally. Maintain a high level of product knowledge and stay updated on industry trends. Claims Processing: Manage a high volume of incoming claims while adhering to strict deadlines. Conduct thorough investigations of claims by reviewing policy details, medical records, and supporting documentation. Determine claim eligibility, liability, and appropriate payout amounts based on policy terms and industry guidelines. Communicate effectively with claimants, healthcare providers, and internal stakeholders. Develops an understanding of the grievance and appeals process available to dissatisfied beneficiaries and providers. Assist members with reconsideration requests for denied claims, gathering necessary documentation, and supporting their appeals. Data Management: Document customer interactions, issues, and resolutions in the appropriate systems. Maintain accurate and up-to-date records of customer accounts and claims information. Identify trends in customer inquiries and provide feedback to improve processes. Quality Assurance: Adhere to established quality standards and compliance regulations. Participate in quality assurance initiatives to ensure customer satisfaction. Assist members with troubleshooting issues related to the member website, guiding them through navigation and resolving technical problems such as resetting access. Answer general questions about health/dental insurance plans, providing comprehensive and accurate information on various topics. Required Qualifications (Non-Negotiable) High school diploma or equivalent; college degree preferred. Minimum 2 years' experience in healthcare BPO, call center, or healthcare customer service Familiarity with Medicare processes and patient care protocols is a plus. Working healthcare knowledge of benefits, eligibility, and medical claims processing Strong English communication, active listening, and multitasking skills High attention to detail and discretion when handling sensitive information Able to perform in a high-volume, deadline-driven environment Advantage: Experience supporting Medicare members/patients Familiarity with ICD-9/ICD-10 coding Additional Benefits: Comprehensive HMO Coverage - Medical & Dental HMO coverage on Day 1 plus 1 dependen About Imagenet Imagenet is a technology-forward healthcare operations partner with more than 25 years of experience helping healthcare payers manage critical administrative and operational processes. Founded in 2000 and headquartered in Tampa, Florida, Imagenet supports 150+ health plans through its payer clients. Our teams help improve efficiency, accuracy, visibility, and service across complex healthcare operations, including digital mailroom, claims adjudication, contact center, member communications, and related administrative functions. By combining experienced operational teams, proven processes, and purpose-built workflow technology, Imagenet helps payers keep essential processes moving for the members, providers, and communities they serve. Imagenet operates 10 secure facilities across the U.S. and one secure facility in Manila, Philippines. Joining Imagenet means contributing to work that supports the healthcare operations members and providers rely on every day.