Customer Service Representative – Healthcare Account – Manila, Philippines

Are you a strong communicator with a genuine passion for helping others? Fusion CX is hiring Customer Service Representatives for our Healthcare Account in Manila. In this role, you will assist beneficiaries with critical healthcare services, ensuring accuracy, empathy, and professionalism in every interaction. If you are searching for healthcare customer service jobs in Manila, call center roles in the Philippines, or CSR opportunities in the healthcare sector, this is your chance to grow with a global customer experience company where care meets excellence.

Job Description

As a Member Services Advocate, you will be part of a team that transforms customer service into customer care by delivering an outstanding experience. You will assist beneficiaries with a wide range of essential services, including updating account information, providing plan details, and resolving issues related to plan utilization. Successful candidates will demonstrate empathy, attention to detail, strong organizational skills, and a genuine commitment to helping people.

Key Responsibilities

• As customers share concerns and feedback, recognize and complete the necessary steps to meet their needs while leaving a lasting, positive impression.
• Help customers understand their benefits and act as their advocate, ensuring clarity and support throughout each interaction.
• Update account information such as billing options and changes in address or contact details.
• Identify and file member or customer grievances related to the program and all associated parties.
• Research premium billing discrepancies and prescription claim issues as needed.
• Educate beneficiaries about how their plan works, including benefits, cost-sharing, and levels of coverage.
• Process mail requests for items such as ID cards and formularies.
• Verify medicine coverage on formularies, explaining tiers, copay levels, and reasons for non-coverage when applicable.
• Display a positive demeanor, technical accuracy, and adherence to company policies at all times.
• Understand and follow CMS guidance, ensuring that applicable exhibits are mailed as required.
• Maintain HIPAA compliance and ensure confidentiality in all customer interactions.
• Record concise, detailed notes for all member records.
• Handle outbound calls to validate information and inbound calls to assist members with accuracy and efficiency.
• Escalate any member issues to management as necessary.
• Maintain high call quality standards in line with client requirements, including a 95% quality score and timely response rates (80–85% of calls answered within 30 seconds or less).
• Meet all assigned program metrics on a monthly basis.
• Communicate with coworkers, management, staff, and customers courteously and professionally.
• Follow all regulations, company policies, and standard operating procedures.
• Respond promptly to phone calls, correspondence, and faxes.
• Maintain professional conduct and behavior, reflecting a positive image of the company.

Job Requirements:

Qualifications & Requirements

• Must have healthcare account experience.
• Must be able to provide clear information about healthcare coverage and available options.
• Must be willing to work on-site in Manila.
• Must have excellent verbal and written communication skills.
• Strong problem-solving skills, attention to detail, and ability to handle sensitive inquiries.
• Empathetic, detail-oriented, and able to manage complex issues with professionalism.
• A friendly, helpful attitude and a genuine desire to assist others.

Why Join Fusion CX Manila?

At Fusion CX, customer service is built on empathy, understanding, and trust. As a Customer Service Representative for our Healthcare Account, you’ll make a difference every day by helping people navigate their healthcare needs with clarity and care.

• Purpose-Driven Work: Make a real impact by helping beneficiaries access and understand their healthcare plans.
• Growth-Oriented Culture: Develop your skills through structured training, coaching, and mentorship.
• Professional Environment: Work with supportive leaders and teams who value quality and compassion.
• Meaningful Career Path: Build long-term growth in a global company known for its commitment to people and service excellence.

If you’re looking for healthcare customer service jobs in Manila, call center healthcare roles, or CSR opportunities in the Philippines, apply now and grow your career with Fusion CX, where care meets capability.