Sagility

Sales

• Engage members using a consultative approach, uncovering needs and providing tailored solutions that build trust and drive enrollment.
• Demonstrate exceptional attention to detail when verifying eligibility, collecting data, and updating CRM systems.
• Conduct outbound calls to individuals who may qualify for healthcare and/or public assistance, following approved scripts and compliance guidelines.
• Verify eligibility requirements by gathering demographic, household, and income information from members.
• Educate members on Medicaid benefits, enrollment steps, required documentation, and timelines.
• Assist with applications by walking members through the process or directing them to appropriate resources.
• Maintain accurate, timely, and complete records in CRM or eligibility systems to ensure compliance and operational excellence.
• Identify barriers (such as lack of documents, confusion about requirements, or language needs) and provide solutions or escalate to support teams.
• Ensure compliance with HIPAA and state/federal regulations during all interactions.
• Promote a positive member experience by showing empathy, professionalism, and patience, especially when working with vulnerable or underserved populations.
• Meet performance metrics, including call volume, quality assurance scores, first-call resolution, and enrollment targets.
• Be receptive to feedback for continuous improvement.
• Document and report member DNC and program opt-out requests.

Outbound Sales and Enrollment Coordinator

Credentialing Specialist

• Verify provider credentials through approved sources in a timely and accurate manner
• Track and process credentialing and re-credentialing applications
• Enter and update provider information in the credentialing database
• Maintain and update provider demographics
• Monitor and manage data from delegated entities
• Communicate with providers or their office staff regarding credentialing status and required documentation
• Identify and report non-compliance or credentialing issues to the supervisor
• Ensure confidentiality of sensitive data and documents
• Perform other duties as assigned

Claims Specialist

• Review medical claims thoroughly to ensure no missing or incomplete information
• Navigate multiple computer systems and platforms to research and process assigned claims accurately (e.g., verifying pricing, prior authorizations)
• Apply appropriate benefits to each claim in accordance with claims processing policies, including grievance procedures, state mandates, CMS guidelines, and benefit plan documents
• Review documentation to assess whether the visit was necessary and whether the policy covers the treatment received
• Determine if claims should be paid or denied, and complete denial letters when applicable

Claims Processor

Customer Support

• Handle incoming calls promptly and professionally.
• Research and provide effective resolutions to customer inquiries.
• Accurately document call details.
• Communicate empathetically and diplomatically with clear, professional articulation.
• Meet team goals for quality and customer satisfaction daily.

Customer Service Representative, Healthcare

• Answer inbound calls and place outbound calls to assist members or patients with inquiries, benefits, scheduling, and service coordination
• Provide accurate information about health plan benefits, eligibility, and coverage
• Schedule, reschedule, and confirm appointments with healthcare providers
• Process referrals, authorizations, prescription renewals, and other requests
• Assist members or patients with claims questions, billing inquiries, and account updates
• Review insurance or plan eligibility and update records in the system
• Maintain accurate documentation in electronic systems, including EMR or CRM tools
• Communicate with providers and internal teams via phone, secure messaging, or email
• Protect member and patient confidentiality and follow HIPAA or applicable privacy guidelines
• Escalate complex issues to the appropriate team or supervisor for resolution

Outbound Sales and Enrollment Coordinator

Credentialing Specialist

Claims Processor

Customer Service Representative, Healthcare

Healthcare Customer Service Specialist