[Hiring] Care Specialist-Clinical Operations @Sagility

Role Description

The Care Specialist-Clinical Operations will be responsible for:

• Receiving inbound calls from members, physicians, clients, and others to process requests per Sagility LLC policies and guidelines.
• Conducting outbound call projects to members for enrollment purposes, customer satisfaction surveys, and other outbound projects.
• Routing messages to appropriate nurse and making pertinent notes in patient charts when necessary.
• Ensuring that notes are clear and timely.
• Using applications according to policies and guidelines to ensure quality delivery of services.
• Maintaining a mutually effective working relationship with callers, physician offices, clients, team members, supervisors, and internal customers.
• Maintaining confidentiality of all patients according to HIPAA standards.
• Collecting and validating patient demographic information including insurance type and patient contact information.
• Obtaining pre-certification or authorization numbers if necessary for referral.
• Regular, reliable attendance and timeliness.
• Performing other duties as assigned.

Qualifications

• High School Diploma or equivalent required.
• A minimum of 1-year experience working in an office setting as a receptionist, telephone customer service representative, or telemarketing representative required.
• Direct experience in a telehealth support function preferred.
• Good communication skills via telephone with members, customers, peers, and superiors.

Requirements

• Basic Competency Level in the following:
• Excellent interpersonal skills.
• Ability to understand and interpret policy provisions.
• Product knowledge.
• Typing skills.
• Problem-solving skills.
• Proficient computer skills.
• Demonstrates empathy.
• Moderate Competency Level in the following:
• Strong member advocate: willing to go above and beyond normal responsibilities to provide the best service possible.
• Ability to assist members in navigating the healthcare system and community-based resources.
• Culturally sensitive and competent for assigned membership.
• Strong organizational skills; ability to multi-task and be nimble.
• Ability to work remotely.
• Ability to determine when to escalate issues appropriately and in a timely manner.

Company Description

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.