Customer Service Representative

LIFE AND HEALTH HMP, INC.

Is currently looking for:

CUSTOMER SERVICE REPRESENTATIVE (Male-preferred)

(Cebu City office)

Job Summary:

The Customer Service Representative (CSR) is responsible for providing exceptional support to members, employers, and healthcare providers. The role requires a deep understanding of the entire process—from membership enrollment, benefit coverage, claims processing, to provider coordination—to ensure seamless service delivery and member satisfaction.

Duties/Responsibilities:

• Respond to inquiries from members regarding benefits, coverage, and procedures.
• Guide members through the process of accessing services, including preventive care, consultations, and diagnostics.
• Assist members in resolving complaints or concerns promptly and professionally.
• Handle inbound calls to ensure effective communication between providers and members.

• Provide basic knowledge to member regarding enrollments, updates, cancellations, and dependent additions.
• Provide basic background to new members on benefits and usage procedures.

• Assist members and providers with claims submission requirements.
• Provide basic requirements on claims and coordinate with relevant departments to expedite resolution.

• Maintain relationships with network providers and assist them with member queries.
• Coordinate with clinics, hospitals, and diagnostic centers regarding referrals, authorizations, and billings.
• Ensure providers comply with protocols and standards.

• Demonstrate thorough knowledge of process flow, including enrollment, consultation, diagnostic, IPD/OPD, and claims procedures.
• Ensure compliance with internal policies and regulatory requirements.
• Identify process gaps and suggest improvements for efficiency and member satisfaction.

• Prepare daily, weekly, or monthly reports on member inquiries, complaints, and resolutions.
• Maintain accurate logs of member interactions for audit and reference purposes.
• Perform other task assigned by management relevant to maintaining operational efficiency.

Required Skills/Abilities:

• Member-focused mindset
• Attention to detail
• Ability to handle confidential information with discretion
• Conflict resolution and negotiation skills
• Initiative and process improvement orientation

Education and Experience:

• Any Bachelor’s Degree holder
• Background in nursing or any medical-related course is an advantage but not required
• At least 1–2 years of experience in HMO operations or healthcare customer service.
• Strong understanding of HMO processes, benefits, and regulatory requirements.
• Excellent communication, interpersonal, and problem-solving skills.
• Ability to multitask, prioritize, and work efficiently in a fast-paced environment.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook) at an above-average typing speed.