Healthcare Representative

The Healthcare Representative serves as the primary point of contact for patients, healthcare providers, insurance companies, and other stakeholders. This role is responsible for handling inquiries, verifying patient and insurance information, coordinating healthcare services, resolving issues, and ensuring a positive customer experience while maintaining compliance with healthcare regulations and organizational policies.

Key Responsibilities

Customer Service & Patient Support

• Handle inbound and outbound calls, emails, and other communication channels professionally and efficiently.
• Assist patients, providers, and members with inquiries related to healthcare services, benefits, claims, billing, and appointments.
• Provide accurate information regarding healthcare plans, coverage, eligibility, and service requirements.
• Address concerns and resolve issues while ensuring a high level of customer satisfaction.

Healthcare Coordination

• Verify patient demographics, insurance coverage, and eligibility information.
• Coordinate appointments, referrals, authorizations, and healthcare services as required.
• Collaborate with healthcare providers, insurance carriers, and internal departments to facilitate seamless service delivery.
• Follow up on pending requests and ensure timely resolution of cases.

Documentation & Compliance

• Accurately document all interactions, transactions, and case activities in the designated systems.
• Maintain confidentiality of patient information and comply with HIPAA and healthcare privacy regulations.
• Adhere to company policies, client requirements, and healthcare industry standards.
• Ensure all records are updated and maintained accurately.

Claims & Benefits Support

• Assist with claims status inquiries, benefits verification, and coverage-related concerns.
• Explain healthcare benefits, policies, and procedures to patients and members.
• Support issue resolution related to claims processing, billing discrepancies, and payment inquiries.
• Escalate complex cases to the appropriate department when necessary.

Performance & Quality

• Meet established productivity, attendance, quality, and customer satisfaction targets.
• Participate in training and continuous improvement initiatives.
• Stay updated on healthcare policies, processes, and client requirements.
• Contribute to team goals and operational excellence initiatives.

Qualifications

• High School Diploma, Senior High School Graduate, or equivalent; Bachelor's degree preferred.
• At least 1 year of customer service, healthcare support, healthcare account, or BPO experience preferred.
• Experience handling healthcare insurance, provider services, patient support, claims, or benefits is an advantage.
• Strong verbal and written English communication skills.
• Excellent customer service, problem-solving, and interpersonal skills.
• Ability to multitask and work in a fast-paced environment.
• Proficiency in MS Office applications and healthcare systems is preferred.