Customer Care Specialist - Healthcare Makati City at Health… · Makati

The Customer Care Specialist is responsible for delivering excellent customer and patient service throughout the healthcare service journey, from initial inquiries and appointment coordination to service completion, billing assistance, HMO processing, and post-service follow-up.

The role also manages relationships with existing individual and corporate clients, coordinates with Health Maintenance Organization (HMO) providers, insurance companies, and corporate accounts, and ensures the accurate and timely processing of service requests, approvals, billing documents, and client concerns.

The position serves as a key liaison among patients, existing clients, healthcare professionals, HMO providers, Billing and Finance, and other internal departments to ensure a seamless, responsive, compliant, and patient-centered experience.

1. Key Responsibilities

A. Customer and Patient Service Management

• Respond to patient and customer inquiries through walk-in, telephone, email, messaging platforms, and other authorized communication channels.
• Provide accurate information regarding healthcare services, procedures, schedules, requirements, service fees, payment options, and turnaround times.
• Assist patients with appointments, registration, service coordination, documentation requirements, and other administrative needs.
• Ensure courteous, professional, empathetic, and timely handling of customer interactions.
• Manage customer complaints, service requests, and feedback; coordinate with relevant departments to facilitate timely resolution.
• Monitor pending concerns and provide appropriate updates until closure.
• Protect patient confidentiality and comply with data privacy requirements when handling personal and medical information.

B. Existing Client and Account Management

• Maintain positive working relationships with existing individual, corporate, institutional, and HMO clients.
• Serve as a primary contact for routine client inquiries, service coordination, account updates, and administrative requests.
• Coordinate service requirements, appointments, schedules, service availments, and documentation with existing clients.
• Monitor client requests and commitments to ensure timely delivery of agreed services.
• Conduct client follow-ups to confirm service completion, address concerns, and assess satisfaction.
• Maintain accurate client profiles, contact details, account records, service histories, and communication logs.
• Identify recurring client concerns and recommend improvements to service delivery and client retention.
• Escalate account risks, recurring service issues, and requests requiring commercial or management approval.
• Support client retention and relationship-building initiatives in coordination with the Account Management, Sales, or Business Development team, as applicable.

C. HMO and Healthcare Insurance Processing

• Verify patient eligibility, HMO membership, coverage, and applicable benefit requirements through authorized systems or provider channels.
• Assist in processing Letters of Authorization (LOAs), approvals, eligibility confirmations, and other required HMO documents.
• Coordinate with HMO representatives regarding coverage verification, approval status, exclusions, limits, and documentation requirements.
• Ensure that required forms, medical orders, supporting documents, and other claim-related records are complete and accurate.
• Monitor pending approvals and follow up on delayed or incomplete HMO transactions.
• Explain administrative HMO requirements and applicable patient payment responsibilities based on verified information and approved company procedures.
• Coordinate with healthcare professionals and internal departments to obtain necessary supporting documents.
• Maintain an organized record of HMO transactions, approvals, denials, pending cases, and related correspondence.
• Refer coverage disputes, denied authorizations, and complex benefit interpretations to the designated HMO or billing authority.
• Observe applicable HMO agreements, company procedures, data privacy requirements, and documentation standards.

D. Billing, Payment Coordination, and Financial Documentation

• Prepare, review, or coordinate billing documents based on approved service records, rates, contracts, and billing procedures.
• Verify the completeness and accuracy of patient charges, corporate billings, HMO transactions, and supporting documentation within the scope of the role.
• Explain itemized charges, payment requirements, official billing procedures, and account status using verified information.
• Coordinate with Billing and Finance regarding discrepancies, adjustments, payment posting, credit arrangements, and billing clarifications.
• Assist in preparing invoices, statements of account, billing summaries, and supporting documents for corporate and HMO accounts, where authorized.
• Monitor pending billing documents and follow up on incomplete requirements that may delay submission or payment.
• Support the preparation of HMO and corporate billing packages for submission within agreed timelines.
• Maintain accurate billing logs and transaction records for reconciliation, audit, and reporting.
• Escalate billing disputes, suspected discrepancies, unauthorized charges, and unusual transactions to the appropriate authority.
• Handle payments or payment-related documents only within authorized responsibilities and established financial controls.

E. Service Coordination and Operational Support

• Coordinate with laboratory, radiology, medical, nursing, pharmacy, records, and other relevant units to facilitate patient and client requirements, as applicable to the facility.
• Monitor service requests and communicate relevant updates to patients and clients without disclosing unauthorized clinical information.
• Ensure that administrative documents are complete, properly routed, and processed within established turnaround times.
• Assist in coordinating corporate medical services, executive checkups, diagnostic packages, clinic schedules, and other contracted services, where applicable.
• Track service delays, incomplete transactions, and unresolved operational concerns.
• Support the implementation of customer service standards, standard operating procedures, and service recovery initiatives.
• Maintain organized physical and electronic files in accordance with document control and retention requirements.

F. Customer Feedback, Complaints, and Service Recovery

• Receive, document, acknowledge, and route complaints and feedback to the appropriate department or authorized decision-maker.
• Conduct initial fact-finding within the scope of the role and coordinate service recovery actions.
• Monitor complaint resolution timelines and follow up with concerned departments.
• Maintain a complaint and service recovery log, including case status, actions taken, escalation, and closure.
• Identify recurring concerns and recommend corrective and preventive measures.
• Escalate complaints involving patient safety, clinical judgment, potential medical errors, confidentiality breaches, discrimination, or other serious concerns immediately through established channels.
• Ensure that complaints are handled objectively, confidentially, and without retaliation against individuals who raise legitimate concerns.

G. Documentation, Reporting, and Continuous Improvement

• Maintain accurate records of customer interactions, client requests, HMO transactions, billing activities, complaints, and service outcomes.
• Prepare daily, weekly, or monthly reports on transaction volumes, pending approvals, billing submissions, complaint resolution, client requests, and other assigned performance indicators.
• Monitor turnaround times, processing accuracy, service levels, and unresolved cases.
• Identify opportunities to improve customer experience, streamline HMO processing, reduce billing errors, and strengthen client servicing.
• Participate in team meetings, quality audits, service improvement initiatives, and process reviews.
• Perform other related duties consistent with the position and the employee's competence and authorization.

2. Qualifications and Requirements

Educational background

• Bachelor's degree in Business Administration, Healthcare Administration, Management, Communications, or a related field.
• Relevant experience may be considered in accordance with company hiring policies.

Work experience

• At least one (1) to three (3) years of experience in customer service, patient services, healthcare administration, HMO processing, billing support, or client account servicing.
• Experience in a hospital, diagnostic center, medical clinic, laboratory, or other healthcare environment is preferred.
• Experience handling corporate accounts, HMO transactions, insurance documentation, and billing coordination is an advantage.

Technical competencies

• Knowledge of customer service principles and complaint handling.
• Familiarity with HMO eligibility verification, LOA processing, and healthcare billing documentation.
• Proficiency in Microsoft Office applications, email, spreadsheets, and customer service systems.
• Ability to maintain accurate records, monitor pending transactions, and prepare operational reports.
• Understanding of patient confidentiality, data privacy, and secure document handling.
• Familiarity with healthcare information systems or electronic medical records is an advantage.

Behavioral competencies

• Strong customer orientation and service excellence.
• Empathy, patience, and professionalism.
• Clear written and verbal communication.
• Attention to detail and accuracy.
• Problem-solving and sound judgment.
• Time management and ability to manage competing priorities.
• Accountability and follow-through.
• Collaboration and cross-functional coordination.
• Discretion in handling confidential information.
• Composure when dealing with difficult customers and sensitive situations.

3. Working Relationships

Internal stakeholders

• Customer Care Supervisor or Manager
• Physicians, nurses, and other healthcare professionals
• Laboratory, diagnostic, and clinical operations teams
• Billing and Finance
• HMO and Corporate Accounts teams
• Medical Records and Information Technology
• Quality Assurance and Compliance
• Human Resources and other support departments

External stakeholders

• Patients and their authorized representatives
• Existing individual and corporate clients
• HMO providers and insurance companies
• Corporate HR representatives and account coordinators
• Authorized service partners and other relevant stakeholders

4. Authority and Limitations

The Customer Care Specialist may perform routine service coordination, provide approved service information, process authorized documentation, and escalate customer concerns within established procedures.

The position shall not independently:

• Approve medical procedures, clinical decisions, or treatment recommendations.
• Guarantee HMO coverage or payment without verified authorization.
• Change contracted prices, waive fees, approve refunds, or grant credit outside delegated authority.
• Alter clinical records, billing records, or official documents without proper authorization.
• Disclose patient information to unauthorized persons.
• Make commitments on behalf of the company beyond approved policies, contracts, and delegated authority.

5. General Responsibilities

The employee is expected to:

• Comply with company policies, the Code of Conduct, healthcare protocols, and applicable laws and regulations.
• Observe confidentiality, data privacy, information security, and document retention requirements.
• Maintain professional conduct and respectful communication with patients, clients, colleagues, and healthcare professionals.
• Participate in required training, performance reviews, and service improvement activities.
• Report service risks, billing discrepancies, suspected fraud, patient safety concerns, and data privacy incidents through the appropriate channels.
• Perform other related duties reasonably assigned by the immediate supervisor, consistent with the position's scope and competence.

Pay: Php19,000.00 - Php20,000.00 per month

Benefits:

• Health insurance
• Life insurance

Work Location: In person