Provider Escalation & Resolution Specialist

Provider Escalation & Resolution Specialist

The Provider Escalation & Resolution Specialist will be responsible for providing exceptional customer service and support to clients. This role involves addressing client inquiries, resolving issues, and ensuring a positive client experience. The Provider Escalation & Resolution Specialist will serve as the first point of contact for clients and will work closely with other team members to deliver high-quality service.

What You'll Do:

• Respond to client inquiries via phone, email, and in-person meetings in a timely and professional manner.
• Provide accurate information and assistance to clients regarding products, services, and policies. Requires knowledge of the Zelis products and services.
• Resolve client issues and complaints efficiently, ensuring client satisfaction and retention.
• Manage client accounts, ensuring all client information is up-to-date and accurate.
• Conduct regular check-ins with clients to assess their needs and satisfaction levels.
• Investigate and resolve client issues by coordinating with internal departments.
• Escalate complex issues to higher-level support or management as needed.
• Follow up with clients to ensure their issues are resolved and they are satisfied with the service.
• Maintain detailed and accurate records of client interactions and transactions.
• Prepare and submit regular reports on client inquiries, issues, and resolutions.
• Identify trends in client issues and provide feedback to improve processes and services.
• Stay updated on company products, services, and policies.
• Provide clients with information on new products and services that may meet their needs.
• Participate in team meetings and contribute to the development of client service strategies and high-quality client service experience.
• Support other team members during peak times or when additional help is needed.

What You'll Bring to Zelis:

• 1+ yrs customer service experience.
• Healthcare experience helpful.
• Experience working with healthcare escalation tickets is preferred.
• Troubleshoot ticket-related issues and provide timely and effective resolutions preferred.
• Requires proficiency using AI tools skillfully with an understanding of how to develop/create intelligent prompts and/or agents.
• Excellent written and verbal communication skills.
• Strong problem-solving and conflict resolution skills.
• Ability to work independently and as part of a team.
• Proficiency in Microsoft Office Suite and customer relationship management (CRM) software.

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

Location and Workplace Flexibility

Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. Check out our locations to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership team. In-office work and activities vary based on work and team objectives in accordance with Company policies.

While location expectations vary by role, candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible, and in-office presence is guided by team and business needs rather than a fixed weekly schedule.

Equal Employment Opportunity Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.

Accessibility Support We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email View email address on click.appcast.io.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.