Healthcare Concierge Specialist

Applicants must be located in Plano, TX.

The Healthcare Concierge Specialists is responsible for providing contact center based multi-channel guidance to Zelis SmartShopper health plan and employer group clients’ members (consumers) who are ‘shopping’ for medical procedures at cost effective facilities. 

The ideal candidate should be able to independently communicate, educate, document, and report on all member interactions with minimal supervision. 

Essential Duties & Functions:

• Answers inbound requests from health plans and employer group clients
• 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.
• 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
• 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 Sapphire Digital, 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. 
• Other duties as assigned for the purpose of expanding the CCs knowledge, skills, abilities, and experiences in preparation for advancement and promotion.

Requirements

• An associate’s degree in a healthcare related field is desired, or the equivalent combination of years and experience in a customer service role is required.
• 1-2 years of customer service experience, i.e. quickly developing rapport and credibility with customers are required.
• Familiarity 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 contact center telephone systems.
• Must have proven healthcare literacy skills including the ability to interpret complex medical or surgery procedure information.
• 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.

Benefits

• Full-Time Hours: 40 hours per week schedule
• Supportive Environment: Classroom training, plus ongoing support for your success!
• Great workplace: Daily and weekly incentives to create a fun, competitive, and rewarding environment!
• Benefits: Health Care Plan (Medical, Dental & Vision)
• Growth: Opportunity for professional advancement as we grow!
• Culture: Diverse, welcoming culture with Employee Resource Groups