Care Specialist-Clinical Operations

Job title Care Specialist-Clinical Operations

About Sagility

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.

Job title:

Care Specialist-Clinical Operations

Job Description:

Education:

High School Diploma or equivalent required

Experience:


* A minimum 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

Mandatory Skills:


* With Basic Competency Level in the ff :


* Excellent interpersonal skills


* Ability to understand and interpret policy provisions.


* Product knowledge


* Typing Skills


* Problem Solving Skills


* Proficient computer skills


* Demonstrates empathy


* With Moderate Competency Level in the ff.:


* Strong member advocate: willing to go above and beyond normal responsibilities to provide the best service possible


* Ability to assist member 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

Roles & 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

The above statements are intended...