Call Center Head

JOB PURPOSE

The Call Center Head is responsible in leading the team in providing effective and efficient support to the members. They should monitor the team in assisting the members during outpatient availment, mainly ensuring the proper implementation of customer service experience, proper and appropriate implementation of plan policies resulting to utilization management. 

JOB DESCRIPTION

Take the lead in ensuring that members availing of medical services in accredited medical facilities are assisted accordingly.

Monitor proper manpower complement per shift based on the volume of calls, emails and other forms of communication from accredited medical providers and members.

Ensure that members’ queries, concerns and/or complaints are attended to in a timely and appropriate manner prior to elevating this to the Medical Director.

Keep abreast with current regulations and policies affecting medical services and implementation and provide proper guidance to all concerned.

Spearhead the training of the team members regarding medical updates, utilization management, newly onboarded and renewed account benefits.

Coaching of team members to maintain the correctness of spiels and lines to better serve members during the call regarding their benefit including medical network inquiries, concerns and LOA issuances.

Ensure that the clarity of members' coverage and benefits has been discussed clearly during the call and preventing to incur charges beyond the benefit coverage and advises member on non-covered charges.

Build and maintain good rapport with the accredited hospital, physicians, and provider personnel.

Work with internal and external leaders in areas affecting department operations.

Participate in current process review and development of new and revised work processes, policies and procedures within the team.

QUALIFICATIONS

Education: Must be a college graduate of bachelor’s degree preferably medical allied courses or its equivalent.

Experience: With at least 3 to 5 years of managerial experience handling 300 to 400 headcounts in a BPO or health maintenance organization setting. Preferably with related professional and corporate clinical experience. Demonstrated experience in operations and project management. Insurance or HMO work experience is a plus. 

Knowledge, Skills, and Abilities:

Excellent communication, presentation, coordination, and customer handling skills.

Knowledgeable of medical terminologies and conditions with ability to relate cases is preferred, utilization management, and relationship management.

Excellent knowledge of MS Office Applications

Customer service oriented

With exceptional oral and written communication skills

Organizational skills /attention to details

Decision making skills