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Care Concierge I

Sapphire Digital

Sapphire Digital

Boston, MA, USA
Posted on Tuesday, June 25, 2024

The Care Concierge is responsible for providing call center-based telephonic guidance to Insights and Empowerment (I&E), SmartShopper health plan and employer group clients’ members (consumers) who are ‘shopping’ for medical procedures at cost effective facilities. The Care Concierge reports directly to their SmartShopper Supervisor. The Care Concierge is part of a larger team of Care concierges who provide an exceptional customer experience, always remembering that there is a real person on the other end of the phone who is looking for ongoing assistance, guidance, education, and support to make an informed and confident decision about their medical procedure options. The ideal candidate is able to independently communicate, educate, document, and report on all member interactions with minimal supervision. The position is part of a distributed team located in states in which we do business. Demonstrated expertise working in a secure, digital environment with highly confidential data is essential.

Essential Duties & Functions:

  • Answers inbound calls from I&E's health plan, employer group clients, or I&E employees and family members within 30 seconds or less; providing exceptional and professional assistance in a timely, energetic and polite manner, to their members (consumers) planning to have an elective surgical or medical procedure.

  • Documents and communicates 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.

  • Promotes SmartShopper products and services, influencing consumer use of I&E's products and new program initiatives.

  • Researches, analyzes, and reports any issues related to a member incentive inquiry to the appropriate I&E team, including communicating to the consumer what is being done to resolve the incentive inquiry.

  • Utilizes 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.

  • Collaborates with the respective departments within I&E to identify inquiry trends and to help assist with defining the issue and developing a corrective action plan.

  • Corresponds 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 status of insurance claims.

  • Monitors, documents, and maintains the accurate status for all related inquiry cases, including the assigning of cases to the correct person or team for proper handling and resolution.

  • Reinforces consumer engagement digital or mailing campaigns, by interacting with consumers to ensure consumers are registered and engaged with the SmartShopper program offerings.

  • Actively participates with the SmartShopper Staff Development and QM Specialist on an ongoing basis, ensuring individual education and training requirements are met; including refresher and knowledge check courses are completed within the time allocated.

  • Actively participates with the SmartShopper Staff Development and QM Specialist on an ongoing basis, ensuring individual QM scorecard results and targets are met; maintaining or exceeding consumer satisfaction ratings based on explicit criteria set forth by the I&E, and the SmartShopper Customer Care Team.

  • Actively participates with the finance department to verify status of reward checks and to assure checks are properly voided and documented when the need to re issue reward incentive check arises.

  • Uses analytical thinking and problem-solving to recognize, document, and alert the SmartShopper management team of trends in member calls, complaints, reward incentives not paid, or other department level performance improvement opportunities.

  • Other duties as assigned for the purpose of expanding the Personal Assistant's knowledge, skills, abilities, and experiences in preparation for advancement and promotion within I&E.

  • Assist Leadership team preparing monthly reports on department’s performance.

  • Communicate with member’s site of service to research and document billing discrepancies as they arise.

  • Collaborates with the data team to process reward incentive checks.

Experience, Qualifications, Knowledge and Skills:

  • An Associates degree in a healthcare related field is desired, or the equivalent combination of years and experiences in a customer service role is required.

  • 1-2 years of customer service experiences i.e. quickly developing rapport and credibility with customers are required.

  • Familiar with using and supporting online consumer shopping tools is highly desired.

  • Familiar with using customer relationship management systems (SalesForce) is highly desired.

  • Familiar with using healthcare claims look-up and management systems is highly desired.

  • Familiar with using Microsoft Office applications e.g. Excel, Word, PowerPoint, Outlook, and Gmail, Google Docs, and call center telephone systems.

  • Must have good customer telephonic communication experience and active listening skills.

  • Must have good healthcare literacy skills including the ability to interpret complex medical or surgery procedure information.

  • Must have demonstrable analytical thinking and independent problem-solving skills are required, including the ability to multitask, set priorities and manage time effectively.

  • Must have a good consumer focus with a strong aptitude to work with different personalities, ethnicities and age groups are required.

  • Must have basic knowledge about insurance claims for medical procedures and medical coding e.g. CPT, DRGs etc.

  • Bilingual English/Spanish communication skills are highly desired but not required.

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.

Accessibility Support

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, please email TalentAcquisition@zelis.com

SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you’re contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.