Sagility

Customer Support

• Coordinate credentialing and re-credentialing of healthcare providers (physicians, allied health professionals, and facilities)
• Verify provider qualifications, including education, training, licensure, certifications, work history, and malpractice coverage
• Follow processes and procedures to ensure compliance and accuracy for verification and documentation
• Review data and be able to identify gaps in histories, education or required certifications
• Meet timelines and productivity requirements in a work-from-home environment
• Provide feedback for process improvement
• Other duties as assigned

Customer Service Representative – Healthcare

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

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

• 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

Healthcare Customer Service Specialist

Manager

• Serve as a Domain expert in contract loading, concept validation & flagging discrepancies to ensure payment accuracy
• Lead training initiatives for internal teams and clients
• Provide strategic consulting, designing and delivering training programs
• Ensure operational excellence across teams
• Collaborate with stakeholders to implement best practices and optimize workflows

Customer Service Representative – Healthcare

Claims Processor

Outbound Sales and Enrollment Coordinator

Healthcare Customer Service Specialist

Senior Manager – Payment Integrity