The Truth Behind Healthcare Account | What They Don't Tell You | BPO Account Series | Metacom

Metacom Careers

10 Nov 202314:26

Summary

TLDRThis video is an informative guide for newcomers or career shifters entering healthcare accounts in the BPO industry. It covers what a healthcare account is, the application and training processes, typical work tasks, and common challenges. The video highlights that no medical background is required, although it can be advantageous. Training spans three months, including English skills and healthcare systems. The video also discusses the benefits and drawbacks of healthcare accounts, including salaries, stability, and the complexities of handling claims. Viewers are encouraged to apply for available roles at Medacom.

Takeaways

🔍 A healthcare account in the BPO industry handles administrative and operational tasks for healthcare organizations, such as claims processing, appointment scheduling, and customer support.
📞 Healthcare account agents assist healthcare insurance members or providers with inquiries about medical benefits or claims.
💡 You don’t need a medical background to work in a healthcare account; fresh graduates or those from different employment backgrounds are also welcome.
⌨️ Applicants must pass several tests, including typing speed (usually 36-40 words per minute) and customer service assessments.
🎓 The training for healthcare accounts lasts around three months, with a focus on communication skills, benefits, and claims processing.
📝 During training, agents learn to process claims, handle customer concerns, and analyze claim denials.
👩‍⚕️ Agents deal with both members and medical providers, often checking insurance coverage or clarifying the status of claims.
📑 Healthcare account agents need strong attention to detail, especially when reviewing denied claims or handling complex cases.
💰 The salary for healthcare account agents is competitive, starting at around 21,000 pesos, with incentives and allowances potentially increasing it to 27,000 pesos or more.
🔗 Despite some challenges, such as handling complex claims and blurry documents, healthcare accounts are considered stable and offer career growth opportunities.

Q & A

What is a healthcare account in the BPO industry?
-A healthcare account in the BPO industry refers to the management of administrative and operational processes related to healthcare organizations. This can include services like claims processing, appointment scheduling, medical transcription, healthcare analytics, and customer support.
Do you need a medical background to work in a healthcare account?
-No, a medical background is not required to work in a healthcare account. While a nursing or medical-related course may be an advantage, people with different employment backgrounds, including fresh graduates and undergraduates, can apply as long as they meet the minimum requirements and pass the recruitment process.
What types of tests and assessments are involved in the application process for a healthcare account?
-The application process for a healthcare account includes several tests and assessments, such as a typing test (requiring around 36-40 words per minute) and a customer service assessment to evaluate your ability to handle customer concerns.
What does the training process for a healthcare account involve?
-The training process for a healthcare account typically lasts three months. It includes English communication skills training, benefits and claims training, and practical call-handling training. The first month covers English 101 and benefits training, while the remaining two months focus on claims training and handling calls.
What is the role of a customer service representative in a healthcare account?
-A customer service representative in a healthcare account assists healthcare insurance members or providers with their inquiries, including verifying benefits, processing claims, and clarifying reasons for claim denials. They handle these interactions primarily through phone calls.
What is the difference between member and provider lines in healthcare accounts?
-The member line involves assisting individuals (members) with inquiries about their health insurance, such as benefits and claims, while the provider line involves helping healthcare service providers (e.g., doctors or hospitals) with claim inquiries and service coverage.
How do agents handle claim denials in a healthcare account?
-When a claim is denied, agents review the reason for the denial by analyzing the patient’s plan, relevant documents, and the claim forms. They explain the denial to the member or provider and may guide them on resubmitting or appealing the claim if necessary.
What challenges do healthcare account agents commonly face?
-Common challenges include handling complex or repeatedly denied claims, managing multiple resources and tools for different medical plans, dealing with blurry scanned documents, and coordinating benefits when a member has multiple health insurance plans.
What are the advantages of working in a healthcare account?
-Advantages of working in a healthcare account include stable employment, competitive salaries (with a base of at least PHP 21,000 and potential earnings of up to PHP 27,000 or more), and additional benefits such as transportation, rice, and clothing allowances.
How can candidates improve their chances of passing the interview and assessments for a healthcare account role?
-Candidates can improve their chances by practicing their typing skills on online platforms and preparing for customer service assessments. Enhancing their grammar and communication skills can also be beneficial, and resources like interview guides and tips can help with the preparation process.

Outlines

00:00

👩‍⚕️ Introduction to Healthcare Accounts in the BPO Industry

The video opens by addressing newcomers or career shifters entering healthcare accounts in the BPO industry. The speaker introduces the concept of healthcare accounts, outlining the administrative and operational tasks involved, such as claims processing, appointment scheduling, and customer service. The healthcare account supports both members (patients) and providers (doctors, clinics) regarding medical claims and benefits inquiries. The speaker also dispels the myth that only those with a medical background can apply for these roles, noting that the hiring process is open to a variety of educational and professional backgrounds.

05:02

📝 Overview of the Application Process for Healthcare Accounts

The second paragraph explains the recruitment process for healthcare accounts, detailing the tests and assessments that candidates must pass, such as typing speed and customer service skills. The speaker reassures viewers that a medical background is not required but can be an advantage. The process includes typing tests, customer service assessments, grammar checks, and communication skills evaluations, along with interviews. Upon passing these, candidates are required to complete job requirements like medical exams before beginning their training.

10:02

📚 Healthcare Account Training Structure

The third section focuses on the training process for healthcare account agents. Training lasts about three months, split into English communication skills training, benefits training, and claims training. Agents are prepared to handle conversations with both members and providers, learning how to explain claims denials, process claims, and manage medical benefits. The speaker advises trainees to take notes and emphasizes the importance of understanding various health plans, claims forms, and insurance processes.

Mindmap

Keywords

💡Healthcare Account

A healthcare account in the BPO industry refers to a service where agents manage various administrative tasks for healthcare organizations. These tasks include claims processing, appointment scheduling, and medical transcription. The video emphasizes that healthcare accounts do not require a medical background, though relevant experience can be an advantage.

💡BPO Industry

BPO (Business Process Outsourcing) involves contracting specific business tasks, such as customer service or technical support, to third-party companies. In the context of the video, the BPO industry supports healthcare organizations by providing services such as claims processing and customer support.

💡Claims Processing

Claims processing refers to the review and handling of requests for payment or reimbursement for healthcare services rendered. In a healthcare account, agents review why a claim may have been denied and help members or providers understand the next steps. This is a core responsibility of customer service representatives in healthcare accounts.

💡Members

Members refer to individuals who are covered by a health insurance plan. In the video, customer service representatives in healthcare accounts assist members with inquiries about their benefits, claims, or healthcare services, such as doctor visits or treatments.

💡Providers

Providers are individuals or institutions, such as doctors or hospitals, that offer medical services to members of a healthcare plan. The video explains that customer service agents often assist providers by verifying patient eligibility for services or clarifying claim status.

💡Training Process

The training process in a healthcare account typically spans three months and includes English communication training, benefits training, and claims training. The video highlights the importance of this training for new agents to understand both the technical aspects of healthcare plans and customer service best practices.

💡Benefits Training

Benefits training focuses on teaching agents about healthcare benefits, such as what services are covered under specific health insurance plans. This is an essential part of the training process in a healthcare account, ensuring agents can accurately inform members or providers about coverage.

💡Claims Denial

Claims denial occurs when a healthcare service claim is rejected by the insurance provider. Agents working in a healthcare account are responsible for explaining why a claim was denied and determining whether it can be resubmitted. Attention to detail and understanding of healthcare plans are key to handling these cases.

💡Escalation

Escalation refers to the process of forwarding a complex or unresolved issue to higher-level support. In a healthcare account, agents may need to escalate complicated claims that have been denied multiple times, requiring intervention from more experienced personnel or specialized departments.

💡Coordination of Benefits

Coordination of Benefits (COB) is the process of determining which health insurance plan is primary when a member is covered by more than one plan. The video explains that agents must understand COB rules, as they may need to assist members who are covered by multiple insurance providers.

Highlights

Introduction to healthcare accounts in the BPO industry and how they cover a wide range of services such as claims processing, appointment scheduling, and medical transcription.

Definition of a healthcare account in the BPO context, focusing on assisting healthcare insurance members or providers with benefit or medical claim inquiries.

Healthcare accounts in the BPO industry are open to people without medical backgrounds, including fresh graduates or career shifters.

The application process involves typing tests, customer service assessments, communication skills assessments, and interviews.

Training for healthcare accounts is divided into two main parts: benefits and claims training, followed by system training, which typically lasts for three months.

The first week of training focuses on English communication skills, while the remaining weeks cover benefits training and claims handling.

During training, agents are taught how to fill out claim forms, analyze claim denials, and communicate effectively with healthcare providers and members.

A typical workday involves assisting customers via phone calls, which may include verifying health insurance benefits and claims.

Healthcare accounts support both member and provider lines, focusing on either verifying health services or explaining claim denials.

Common challenges in healthcare accounts include dealing with complicated claims, organizing multiple medical resources, and handling blurry scanned documents.

Agents may encounter coordination of benefits calls, where members are covered by two health plans, adding complexity to claim handling.

Healthcare agents must learn to manage increased average handling time (AHT) and improve efficiency by handling simpler calls faster.

A key advantage of working in a healthcare account is the relatively higher salary, with the basic monthly salary starting at 21,000 pesos and additional incentives reaching up to 27,000 pesos or more.

Healthcare accounts in the BPO industry are considered one of the most stable, offering allowances such as transportation, rice, and clothing allowances.

The video concludes by emphasizing that healthcare accounts are career-shifter-friendly and highlights the benefits of joining a healthcare BPO.