Healthcare Customer Service Representative (Healthcare)

Location: Insular Life, Makati, Metro Manila, Philippines. Work setup is onsite, with possible hybrid work depending on performance, attendance, and business needs. Schedule: five days per week, graveyard shifting schedule, with possible weekend work.

Company

hirify.global is a healthcare operations partner supporting healthcare payers with claims, contact center, member communications, and administrative services.

What you will do

• Handle inbound calls and chats from members, providers, health plans, insurance brokers, and hospitals in accordance with HIPAA guidelines.
• Explain coverage plans, eligibility, benefits, limitations, exclusions, and general health and dental insurance information.
• Process and investigate high volumes of medical claims by reviewing policies, medical records, and supporting documentation.
• Determine claim eligibility, liability, and payout amounts, and coordinate issue resolution with internal departments.
• Support reconsideration requests and appeals for denied claims by gathering documentation and explaining available processes.
• Document interactions and claims accurately, maintain account records, identify inquiry trends, and troubleshoot member website access issues.

Requirements

• High school diploma or equivalent; a college degree is preferred.
• At least two years of experience in healthcare BPO, call center, or healthcare customer service.
• Working knowledge of healthcare benefits, eligibility, and medical claims processing.
• Strong English communication, active listening, multitasking, attention to detail, and discretion with sensitive information.
• Ability to work in a high-volume, deadline-driven environment and follow quality and compliance standards.

Nice to have

• Experience supporting Medicare members or patients.
• Familiarity with Medicare processes, patient care protocols, and ICD-9/ICD-10 coding.

Culture & Benefits

• HMO coverage for medical and dental care from day one.
• HMO coverage includes one dependent.
• Work in a secure healthcare operations facility supporting U.S. healthcare payers and members.