Job Description
Care Coordinator
locations: Remote
time type: Full time
job requisition id: JR101409
At Sapphire, now a part of Zelis, we believe in a world where healthcare consumers empowered with the right information at the right moment will become the best healthcare consumers for themselves, their health plans, and their providers. Are you interested in making an impact and supporting health care consumers? Join Sapphire as a Contact Center Representative!
Location – Remote/Central and Mountain time zones
Essential Duties & Functions:
- Answering inbound calls from Sapphire’s health plan, employer group clients, or Sapphire employees.
- Providing exceptional and professional assistance in a timely, energetic, and polite manner, to members (consumers) planning to have an elective surgical or medical procedure.
- Documenting and communicating information to consumers, including answering inbound calls, emails, or chats; and placing outbound follow-up calls, emails, or chats and/or responding to consumers’ emails or voicemails in a timely manner.
- Utilizing internal databases to run reports on consumer claim history, procedure code matching, accounts on hold, incentive check fulfillment status, claim load schedule, shopping confirmation codes, exception payments, and consumer shopping search history.
- Corresponding with consumer’s health insurance carriers to obtain, validate, and confirm accurate claim status information, or consumer program eligibility status.
- Calling members’ site of service as needed to confirm the status of insurance claims.
- Using analytical thinking and problem-solving to recognize, document, and alert the management team of trends in member calls, complaints, reward incentives not paid, or other department-level performance improvement opportunities.
- Consistent, regular, punctual attendance as scheduled is an essential responsibility of this position.
- Other duties as assigned for the purpose of expanding the individual’s knowledge, skills, abilities, and experiences in preparation for advancement and promotion within Sapphire.
Qualifications:
- High school diploma or GED
- An Associate’s degree in a healthcare-related field (highly desired but not required) or equal work experience.
Experience and Skills:
- 1-2 years of customer service experience i.e., quickly developing rapport and credibility with customers is required.
- 1-2 years of experience in a call center, healthcare/insurance industry, or customer service-related position.
- Strong customer telephonic communication experience and active listening skills.
Preferred skills:
- Familiarity with using healthcare claims look-up, and management systems; using and supporting online consumer shopping tools; CRM (Salesforce).
- Interact with a diverse patient base to ascertain the reason for the call and assist the caller with their questions, concerns, or problems with a focus on first call resolution.
- Demonstrable analytical thinking and independent problem-solving skills, including the ability to multitask, set priorities and manage time effectively.