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:
Job Description:
DUTIES & RESPONSIBILITIES:
- CSAs will answer and resolve inbound telephone calls pertaining to medical products and services about benefit, claim or eligibility and non- clinical Utilization Management issues from a Doctor/Hospital regarding (1) one or more issues about a single Customer, or (2) one or more issues about multiple Customers.
- CSAs will transfer to Company calls pertaining to Company’s products and services other than medical.
- CSAs may be engaged to support the centralized fax administration process to complete necessary research and document production to send an outgoing fax to resolve an inbound inquiry to the customer’s satisfaction.
- Authenticate both the Customer and the Healthcare Professional’s information by means of asking information that should match what is listed in the system.
- Capture all relevant information that transpired in the call and properly document it in the client’s system.
- Protect and secure member’s Protected Health Information (PHI).
- Utilize existing resources to provide resolution to healthcare professional’s concern.
- Maintain professionalism and positive working relationships with team members, internal customers, and external customers.
- Validates and organizes the information received.
- Makes sure that the data received is available to appropriate people and systems within the organization.
- Participate on the online training set by US counterpart for updates.
General Safety and Security
- Protects the organization’s assets by upholding the principles of the Quality Information Security Management System (QISMS).
- Ensures confidentiality, integrity, and availability of information critical to fulfilling the organization’s business functions.
- Remain compliant with the relevant business, local and international regulatory and legislative requirements particularly the Health Insurance Portability and Accountability Act of 1996 (HIPAA), HITECH Act and URAC
COMPETENCY REQUIREMENTS:
With Basic Competency Level in the ff.:
Excellent interpersonal skills Ability to understand and interpret policy provisions. Product knowledge Typing Skills Problem Solving Skills
With Moderate Competency Level in the ff.:
US Healthcare Delivery System Philippine Healthcare Delivery System US Healthcare 101 See Attached Customer Experience Checklist Customer Service orientation Computer literate Interpersonal Skills Sense of Urgency Passion for Excellence
OTHER REQUIREMENTS:
Reports to:
Team Leader
Education and/or Experience:
- Graduate of any 4-yr College Degree; or
- Completed at least 2 years in College with minimum 6 months BPO or Customer Service Experience.
- Preferably with 1 – 2 years of Customer Service experience.
Certificates, Licenses, Registrations:
- N/A
Work environment:
The work environment is professional, office. Business casual attire.
Physical demands:
May require weekend, evening or shifting work schedule.
Work demands:
Complete Customer Service Associate training program and achieve certification.
Location:
Skills Required
- Graduate of any 4-year college degree OR completion of at least 2 years of college plus minimum 6 months BPO/customer service experience
- Minimum 6 months BPO or customer service experience (1-2 years preferred)
- Ability to understand and interpret policy provisions
- Excellent interpersonal and customer service skills
- Typing skills and basic computer literacy
- Problem solving skills and sense of urgency
- Knowledge of US Healthcare Delivery System and basic healthcare concepts (US Healthcare 101)
- Ability to protect and secure PHI, comply with HIPAA, HITECH, and URAC requirements
- Complete Customer Service Associate training program and achieve certification
- Willingness to work weekends, evenings, or shifts as required
What We Do
Sagility is a technology-led healthcare operations and business process optimization partner serving payers and providers. It combines healthcare expertise with artificial intelligence, intelligent automation, analytics, cloud platforms, consulting, and BPaaS to streamline claims, membership, clinical, payment-integrity, provider-network, and revenue-cycle workflows across the healthcare ecosystem. Its goal is to reduce administrative costs, improve member and provider experiences, and support better clinical and financial outcomes.
