JOB SUMMARY 

Responsible for prompt, accurate and effective handling of healthcare related telephone inquiries and concerns. 

DUTIES AND RESPONSIBILITIES 

1. STRATEGY MANAGEMENT 

1. Sets customer service objectives and strategies through customer service biannual meeting in support of the goals and objectives of the Customer Service section of the Healthcare Division. 

2. FINANCIAL MANAGEMENT 

1. Handles explanation of benefits and limitations of coverage to members for inpatient and outpatient availments through calls, texts, and emails. 

3. CUSTOMER MANAGEMENT

 INTERNAL and EXTERNAL 

1. Receives, attends to, and records telephone inquiries, concerns and feedbacks; elevates complex complaints from clients to immediate superior.
2. Coordinates with Liaison officers and backroom staff in order to effectively address client concerns.
3. Issues Letter of Authority/control number for hospital admissions and releases diagnostic control numbers for approved diagnostic procedures.
4. Pouches outpatient forms to all providers Monitors, records data, and checks status, benefits and medical records of admitted patients.
5. Monitors in-patient admissions in areas without liaison officers. 

     D. PROCESS MANAGEMENT 

1. Accountable in providing correct approvals for in and outpatient availment
2. Provides delivery of courteous, fair, prompt, and effective service to customers.
3. Provides assistance/support in directing issues or concerns related to other Cocolife Health care departments.

1. Provides documentation and resolution of customer concerns coming from phone calls, text messages, and emails.

1. Provides assistance/support to liaison officers in determining inpatient approvals that is appropriate in relation to the member’s schedule of benefits.