About This Role
This Call Center Representative role involves providing comprehensive support to customers regarding their medical, dental, vision, and drug coverage, as well as claims and pre-certification determinations. The position requires troubleshooting issues, documenting customer interactions, and coordinating services with other departments and international offices.
Responsibilities
- Provide customers with information and/or explanation of medical, dental, vision, and/or drug coverage based on the member’s schedule of benefits
- Provide customers with information and/or explanation on claim determinations
- Provide customers with status and/or explanation of pre-certification determinations
- Troubleshoot errors in pre-certification determinations versus the schedule of benefits
- Troubleshoot errors in claim determinations versus the schedule of benefits or pre-certification
- Provide clear and concise summaries on customer encounters through the company’s Call Tracking program
- Report details and timelines of difficult or complex encounters/cases to Supervisor
- Report daily workflow to Main Operator
- Provide customers with information and/or explanation of processes (i.e., filing deductible/reimbursement claims, off-island coverage/access and coordination process, enrollment requirements and process, pre-certification requirements and process, etc.)
- Coordinate members’ services and appointments with our Philippine offices
- Collaborate with other departments to resolve issues or gain insight on cases
- Perform any other job-related duties as assigned by Supervisor
Requirements
- High school diploma or equivalent (college level preferred)
- Strong communication and listening skills
- Basic computer proficiency
- Medical/health insurance background preferred but not required
- Experience with Microsoft Office (e.g., Outlook Express, Microsoft Word/Excel)
- Experience with operating Xerox machine (e.g., Copy, Fax, and Scan)
- Able to handle multiple assignments under high pressure
- Highly organized and dedicated with a positive attitude
- Thrive on working in a challenging environment
- Team player
- Ability to handle difficult customers
Benefits
- Career growth
- Employee benefits
Important Details
- Application deadline: November 23, 2026
Application Process
- Only pre-screened applicants will be called for an interview
