Care Specialist-Clinical Operations

Sagility

2d•Remote

About The Position

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Requirements

High School Diploma or equivalent required
A minimum 1-year experience working in an office setting as a receptionist, telephone customer service representative, or telemarketing representative required.
Good communication skills via telephone with members, customers, peers and superiors
Basic Competency Level in: Excellent interpersonal skills
Basic Competency Level in: Ability to understand and interpret policy provisions.
Basic Competency Level in: Product knowledge
Basic Competency Level in: Typing Skills
Basic Competency Level in: Problem Solving Skills
Basic Competency Level in: Proficient computer skills
Basic Competency Level in: Demonstrates empathy
Moderate Competency Level in: Strong member advocate: willing to go above and beyond normal responsibilities to provide the best service possible
Moderate Competency Level in: Ability to assist member in navigating the healthcare system and community-based resources
Moderate Competency Level in: Culturally sensitive and competent for assigned membership
Moderate Competency Level in: Strong organizational skills; ability to multi-task and be nimble
Moderate Competency Level in: Ability to work remotely
Moderate Competency Level in: Ability to determine when to escalate issues appropriately and in a timely manner

Nice To Haves

Direct experience in a telehealth support function preferred.

Responsibilities

May work in multiple products receiving inbound calls from members, physicians, clients and others to process requests per Sagility LLC policies and guidelines
May work in multiple products conducting outbound call projects to members for enrollment purposes, customer satisfaction surveys, and other outbound projects
Routes messages to appropriate nurse and makes pertinent notes in patient charts when necessary.
Ensures that notes are clear and timely
Uses applications according to policies and guidelines to ensure quality delivery of services.
Maintains a mutually effective working relationship with callers, physician offices, clients, team members, supervisors, and internal customers
Maintains confidentiality of all patients according to HIPAA standards.
Collects and validates patient demographic information including insurance type and patient contact information
Obtains pre-certification or authorization numbers if necessary for referral
Regular, reliable attendance and timeliness
Other duties as assigned