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!
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.
Experience, Qualifications, Knowledge, and Skills
High school diploma or GED
An Associate’s degree in a healthcare-related field (highly desired but not required) or equal work experience.
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.
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.
As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We’re Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.
Commitment to Diversity, Equity, Inclusion, and Belonging
At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.
Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
We encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, to request the reasonable accommodation request form, please email TalentAcquisition@zelis.com
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