Customer Service Representative - Makati City (Healthcare)

I. POSITION DETAILS

Position Title: Customer Service Representative – Accounts Management and HMO Department: Customer Service / Client Relations Reports To: Customer Service Supervisor / Department Head Employment Type: Full-Time Industry: Healthcare Services

II. JOB PURPOSE

The Customer Service Representative – Accounts Management and HMO is responsible for delivering responsive, accurate, and customer-focused support to patients, corporate clients, Health Maintenance Organizations (HMOs), insurance providers, and other healthcare partners.

The role combines existing account management, HMO coordination, patient assistance, billing and claims support, and service issue resolution to ensure seamless healthcare transactions, maintain strong client relationships, and support revenue collection and operational efficiency.

The position serves as a key liaison among clients, patients, HMO providers, healthcare professionals, billing personnel, and internal operational teams to facilitate timely service delivery, accurate documentation, and effective resolution of concerns.

III. KEY RESPONSIBILITIESA. Customer Service and Patient Assistance

• Respond to inquiries, requests, and concerns from patients, corporate clients, HMO members, and other stakeholders through phone, email, and other communication channels.
• Provide accurate information regarding healthcare services, appointment procedures, service availability, requirements, and billing processes.
• Assist patients and clients throughout the service process, including registration, HMO verification, authorization, billing clarification, and follow-up.
• Handle complaints and service-related issues professionally, ensuring timely resolution or escalation to the appropriate department.
• Maintain a high standard of customer service, confidentiality, professionalism, and patient-centered communication.

B. Existing Corporate Accounts Management

• Manage day-to-day coordination with assigned corporate accounts, institutional clients, and partner organizations.
• Maintain positive working relationships with existing clients to support client satisfaction, retention, and continued utilization of healthcare services.
• Serve as the primary point of contact for account-related inquiries, service requests, documentation, and operational concerns.
• Monitor account activity, service utilization, pending requests, and recurring client concerns.
• Coordinate with internal departments to ensure that client requirements, service commitments, and agreed turnaround times are met.
• Conduct regular client follow-ups to gather feedback, address service gaps, and identify opportunities to improve the client experience.
• Maintain updated client profiles, contact directories, service agreements, account records, and other relevant documentation.
• Support account reviews and prepare periodic reports on client activity, service concerns, utilization, and account status.
• Assist in client onboarding, account orientation, and the implementation of agreed service arrangements.
• Identify opportunities to strengthen existing client relationships and endorse potential service expansion opportunities to the appropriate business development or account management personnel.

C. HMO and Healthcare Partner Coordination

• Coordinate with HMO providers and insurance companies regarding member eligibility, coverage verification, benefit limitations, and required documentation.
• Process and monitor HMO Letters of Authorization (LOAs), approvals, guarantees, and other required pre-authorization documents, as applicable.
• Verify patient membership information and confirm applicable coverage before service delivery, subject to established policies and authorization procedures.
• Coordinate with HMO representatives to clarify benefit coverage, exclusions, approval requirements, and discrepancies.
• Monitor pending HMO approvals and follow up on delayed authorizations to minimize service interruptions.
• Assist patients and healthcare personnel in understanding HMO requirements, covered services, and applicable out-of-pocket expenses, based on verified information.
• Ensure the completeness and accuracy of HMO-related documents, forms, patient records, and transaction details.
• Coordinate with billing and claims personnel regarding rejected claims, incomplete submissions, discrepancies, and outstanding HMO transactions.
• Maintain an updated monitoring log of HMO approvals, pending cases, rejected transactions, and unresolved concerns.
• Build and maintain professional working relationships with HMO coordinators and representatives to facilitate efficient transaction processing.

D. Billing, Claims, and Payment Coordination

• Assist in preparing, validating, and monitoring billing documents for corporate accounts, HMO transactions, and other healthcare services.
• Coordinate with the billing and finance teams to ensure the timely preparation and submission of invoices, statements of account, and supporting documents.
• Monitor outstanding account receivables, pending billings, and unprocessed transactions, and follow up with the appropriate internal teams and clients.
• Assist in reconciling billing discrepancies, payment postings, rejected claims, and disputed charges.
• Track HMO claims and corporate account billings from documentation and submission through status resolution and payment confirmation, as applicable.
• Respond to billing inquiries and explain charges based on approved rates, contracts, service records, and applicable coverage.
• Escalate disputed charges, denied claims, and collection concerns to the appropriate supervisor or department.
• Maintain accurate records of invoices, claims, payment updates, and outstanding billing concerns.

E. Coordination with Internal Healthcare Teams

• Coordinate with clinic or hospital operations, medical personnel, laboratory and diagnostic units, billing, finance, and other relevant departments to facilitate service delivery.
• Ensure that client and patient requests are properly communicated, documented, and acted upon.
• Follow up on pending service requests, medical service documentation, test results routing, and other administrative requirements within authorized responsibilities.
• Support the resolution of operational issues affecting patients, corporate accounts, and HMO transactions.
• Observe established service standards, escalation protocols, and turnaround times.

F. Documentation, Reporting, and Compliance

• Maintain complete, accurate, and up-to-date records of customer interactions, account activities, HMO transactions, billing concerns, and case resolutions.
• Prepare periodic reports on account status, HMO approval turnaround time, pending transactions, billing issues, customer complaints, and service performance.
• Ensure proper handling and confidentiality of patient information, personal data, medical records, and corporate account information.
• Comply with company policies, data privacy requirements, healthcare documentation standards, applicable Philippine regulations, and established operating procedures.
• Ensure that all transactions are supported by appropriate documentation and processed in accordance with approved authority limits.
• Recommend improvements to customer service workflows, HMO processing, account coordination, and documentation procedures.

IV. QUALIFICATIONS

Education

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

Experience

• At least 1–3 years of experience in customer service, healthcare administration, account coordination, HMO processing, medical billing, or a related function.
• Experience handling corporate accounts and coordinating with HMO providers is highly preferred.
• Experience in a hospital, clinic, diagnostic center, medical facility, or other healthcare service organization is an advantage.

Technical Competencies

• Knowledge of HMO eligibility verification, LOA processing, healthcare coverage, and authorization procedures.
• Familiarity with corporate account servicing, billing documentation, claims monitoring, and payment coordination.
• Proficiency in Microsoft Office applications, particularly Excel, Word, and Outlook.
• Ability to use customer relationship management (CRM), healthcare information, billing, or account monitoring systems.
• Strong documentation, reporting, data management, and follow-through skills.

V. CORE COMPETENCIES

• Customer Service Excellence – Demonstrates responsiveness, empathy, professionalism, and a commitment to customer satisfaction.
• Account Relationship Management – Maintains positive relationships with existing clients and ensures consistent service delivery.
• HMO and Claims Coordination – Understands healthcare authorization requirements and effectively monitors pending transactions.
• Communication and Coordination – Communicates clearly with patients, clients, HMO representatives, and internal stakeholders.
• Problem-Solving and Issue Resolution – Identifies concerns, determines appropriate actions, and escalates unresolved matters promptly.
• Attention to Detail – Ensures accuracy and completeness of patient information, billing records, authorization documents, and reports.
• Time Management and Organization – Prioritizes multiple inquiries, account requirements, and time-sensitive transactions.
• Integrity and Confidentiality – Handles sensitive information responsibly and complies with privacy and ethical standards.
• Results Orientation – Meets service standards, turnaround times, and productivity expectations.

Pay: Php20,000.00 - Php22,000.00 per month

Work Location: In person