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

Zelis • St. Louis, MO

1d • $19 • Remote

About The Position

At Zelis, we Get Stuff Done. So, let’s get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients. A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position Overview The Care Concierge – Member Support Specialist delivers call center-based telephonic support to members (consumers) of Zelis Member Engagement & Transparency and SmartShopper health plan and employer group clients who are actively shopping for cost-effective medical procedures. This role is part of a broader Care Concierge team dedicated to providing an exceptional customer experience, recognizing that each interaction represents an individual seeking guidance, education, and ongoing support to make informed and confident healthcare decisions. The ideal candidate will effectively communicate, educate, document, and report on all member interactions with minimal supervision. This position operates within a distributed team across multiple states where Zelis conducts business. The Care Concierge position is 100% remote and will work an 11:30 am – 8 pm shift. In order to be considered, you must reside 50 miles from a Zelis office location. Zelis offices are located in: Boston, MA Morristown, NJ Atlanta, GA St Petersburg, FL St Louis, MO

Requirements

• Minimum of 1+ year of customer service experience required, including the ability to quickly build rapport and establish credibility with customers.
• Healthcare experience required.
• Proficiency with CX1 and customer relationship management (CRM) systems, such as Salesforce, is strongly desired.
• Familiar with using healthcare claims look-up and management systems is highly desired.
• Associates degree preferred.
• Familiar with using Microsoft Office applications e.g. Excel, Word, PowerPoint, Outlook, and Google Docs.
• Excellent telephone-based customer service, including strong verbal communication and active listening skills required.
• Strong healthcare literacy, with the ability to understand and interpret complex medical and surgical procedure information.
• Analytical and independent problem-solving abilities, with strong multitasking skills and the capacity to prioritize and manage time effectively.
• Customer-focused mindset with the ability to effectively engage individuals of diverse personalities, backgrounds, ethnicities, and age groups.
• Knowledge of medical insurance claims processes and medical coding (e.g., CPT, DRGs) helpful.
• Bilingual English/Spanish communication skills are highly preferred

Nice To Haves

• Experience supporting and navigating online consumer shopping tools is highly preferred.

Responsibilities

• Responds 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 procedures.
• Accurately 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 voicemails.
• Promotes SmartShopper products and services, encouraging consumer engagement with Zelis offerings and supporting adoption of new program initiatives.
• Researches, analyzes, and escalates member incentive inquiries to the appropriate internal team, clearly communicating resolution steps and updates to consumers.
• Leverages 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 history.
• Communicates with consumers’ health insurance carriers to obtain, validate, and confirm accurate claim status and program eligibility information.
• Contacts members’ sites of service, as needed, to verify the status of insurance claims.
• Monitors, documents, and maintains accurate records for all related inquiry cases, ensuring proper case assignment and timely resolution by the appropriate individual or team.
• Supports digital and direct mail engagement campaigns by interacting with consumers to confirm registration and encourage active participation in SmartShopper program offerings.
• Partners 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 timeframes.
• Collaborates 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 standards.
• Works closely with the Finance team to verify reward check status and ensure proper documentation and voiding when reissuing incentive payments is necessary.
• Applies 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 leadership.
• Communicates with members’ sites of service to research and document billing discrepancies as they arise.
• Collaborates with the Data team to support the processing and distribution of reward incentive checks.

Benefits

• Zelis’ full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees’ health, well-being, and financial protection.
• The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree