[Remote] Care Concierge - Member Support Specialist - 11:30 am - 8 pm EST Shift

Note: The job is a remote job and is open to candidates in USA. Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. The Care Concierge – Member Support Specialist delivers call center-based telephonic support to members, providing exceptional customer service and assistance in navigating healthcare procedures and services.ResponsibilitiesResponds to inbound calls from health plans, employer groups, employees, and family members within 30 seconds, delivering exceptional, professional support in a timely, courteous, and energetic manner to members planning an elective surgical or medical proceduresAccurately documents and communicates consumer interactions, including handling inbound calls, emails, and chats, as well as conducting outbound follow-up calls and responding promptly to emails and voicemailsPromotes SmartShopper products and services, encouraging consumer engagement with Zelis offerings and supporting adoption of new program initiativesResearches, analyzes, and escalates member incentive inquiries to the appropriate internal team, clearly communicating resolution steps and updates to consumersLeverages internal databases to generate reports on claim history, procedure code matching, accounts on hold, incentive check fulfillment status, claim load schedules, shopping confirmation codes, exception payments, and consumer search historyCommunicates with consumers’ health insurance carriers to obtain, validate, and confirm accurate claim status and program eligibility informationContacts members’ sites of service, as needed, to verify the status of insurance claimsMonitors, documents, and maintains accurate records for all related inquiry cases, ensuring proper case assignment and timely resolution by the appropriate individual or teamSupports digital and direct mail engagement campaigns by interacting with consumers to confirm registration and encourage active participation in SmartShopper program offeringsPartners regularly with the SmartShopper Staff Development and Quality Management (QM) Specialist to fulfill ongoing education and training requirements, including completing refresher courses and knowledge checks within designated timeframesCollaborates with the SmartShopper Staff Development and QM Specialist to meet or exceed QM scorecard targets and maintain high consumer satisfaction ratings in alignment with Zelis and Customer Care standardsWorks closely with the Finance team to verify reward check status and ensure proper documentation and voiding when reissuing incentive payments is necessaryApplies analytical and problem-solving skills to identify, document, and escalate trends related to member inquiries, complaints, unpaid incentives, and other departmental performance improvement opportunities to leadershipCommunicates with members’ sites of service to research and document billing discrepancies as they ariseCollaborates with the Data team to support the processing and distribution of reward incentive checksSkillsMinimum of 1+ year of customer service experience required, including the ability to quickly build rapport and establish credibility with customersHealthcare experience requiredExcellent telephone-based customer service, including strong verbal communication and active listening skills requiredStrong healthcare literacy, with the ability to understand and interpret complex medical and surgical procedure informationAnalytical and independent problem-solving abilities, with strong multitasking skills and the capacity to prioritize and manage time effectivelyCustomer-focused mindset with the ability to effectively engage individuals of diverse personalities, backgrounds, ethnicities, and age groupsKnowledge of medical insurance claims processes and medical coding (e.g., CPT, DRGs) helpfulBilingual English/Spanish communication skills are highly preferredExperience supporting and navigating online consumer shopping tools is highly preferredProficiency with CX1 and customer relationship management (CRM) systems, such as Salesforce, is strongly desiredFamiliar with using healthcare claims look-up and management systems is highly desiredAssociates degree preferredFamiliar with using Microsoft Office applications e.g. Excel, Word, PowerPoint, Outlook, and Google DocsBenefits401k plan with employer matchFlexible paid time offHolidaysParental leavesLife and disability insuranceHealth benefits including medical, dental, vision, and prescription drug coverageCompany OverviewZelis is modernizing the healthcare financial experience for all. It was founded in 2016, and is headquartered in Bedminster, New Jersey, USA, with a workforce of 1001-5000 employees. Its website is https://www.zelis.com.



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