Customer Care Associate - Healthcare / HMO

Customer Care Associate – Healthcare / HMOJob Summary

InLife Benefits Insurance Company, Inc. (formerly Generali Life Assurance Philippines, Inc.) is one of the Philippines' leading providers of employee benefits, group life insurance, and healthcare solutions.

The Customer Care Associate is responsible for delivering exceptional customer support through inbound and outbound communication channels. The role involves handling eligibility verification, benefit inquiries, Letter of Authority (LOA) issuance, hospital coordination, medical benefit computation, and resolving customer concerns while ensuring excellent service to clients, brokers, healthcare providers, and other stakeholders.

Key Responsibilities

• Handle inbound and outbound calls related to healthcare and HMO services.
• Verify members' eligibility and provide accurate benefit information.
• Respond to inquiries regarding network providers, medical plans, and Schedule of Benefits (SOB).
• Issue Letters of Authority (LOA) for eligible inpatient (IP) and outpatient (OP) availments.
• Coordinate with accredited hospitals and healthcare providers for member admissions and treatment authorization.
• Compute members' eligible medical benefits during hospital discharge and ensure collection of any Excess of Benefits (EOB), when applicable.
• Respond promptly to customer inquiries, requests, and complaints through multiple communication channels, including phone, email, SMS, and mobile applications.
• Provide timely, accurate, and professional customer service while maintaining service quality standards.
• Accurately document customer interactions and update records in the system.
• Perform other duties and responsibilities that may be assigned by management.

Qualifications

Education

• Bachelor's degree in any four-year course.
• Graduates of Nursing, Medical Allied programs, or Business Administration are highly preferred.

Experience

• At least 1 year of experience in a call center, healthcare, customer service, HMO, or insurance environment.
• Experience in healthcare or HMO operations is an advantage.

Knowledge

• Basic understanding of medical terminology, hospital workflows, and healthcare or HMO processes.
• Familiarity with:
• Eligibility verification
• Letter of Authority (LOA) processing
• Medical benefit computation
• Schedule of Benefits (SOB)
• Healthcare insurance policies and procedures

Skills & Competencies

• Excellent verbal and written communication skills in English and Filipino.
• Strong customer service, interpersonal, and problem-solving skills.