Care Concierge I

About the role

Zelis is modernizing the healthcare financial experience in the United States (U.S.) across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients. At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture. Why We Do What We Do In the U.S., consumers, payers, and providers face significant challenges throughout the healthcare financial journey. Zelis helps streamline the process by offering solutions that improve transparency, efficiency, and communication among all parties involved. By addressing the obstacles that patients face in accessing care, navigating the intricacies of insurance claims, and the logistical challenges healthcare providers encounter with processing payments, Zelis aims to create a more seamless and effective healthcare financial system. Zelis India plays a crucial role in this mission by supporting various initiatives that enhance the healthcare financial experience. The local team contributes to the development and implementation of innovative solutions, ensuring that technology and processes are optimized for efficiency and effectiveness. Beyond operational expertise, Zelis India cultivates a collaborative work culture, leadership development, and global exposure, creating a dynamic environment for professional growth. With hybrid work flexibility, comprehensive healthcare benefits, financial wellness programs, and cultural celebrations, we foster a holistic workplace experience. Additionally, the team plays a vital role in maintaining high standards of service delivery and contributes to Zelis' award-winning culture. Position Overview The Care Concierge is responsible for providing call center-based telephonic guidance to Member engagement and Transparency ( ME&T) ,Smart Shopper health plan and employer group clients' members (consumers) who are 'shopping' for medical procedures at cost effective facilities. The Care Concierge reports directly to their SmartShopper Supervisor. The Care Concierge is part of a larger team of Care concierges who provide an exceptional customer experience, always remembering that there is a real person on the other end of the phone who is looking for ongoing assistance, guidance, education, and support to make an informed and confident decision about their medical procedure options. The ideal candidate can independently communicate, educate, document, and report on all member interactions with minimal supervision. The position is part of a distributed team located in states in which we do business. Demonstrated expertise working in a secure, digital environment with highly confidential data is essential. Essential Duties & Functions: Answers inbound calls from ME&T health plan, employer group clients, or ME&T employees and family members within 30 seconds or less; providing exceptional and professional assistance in a timely, energetic and polite manner, to their members (consumers) planning to have an elective surgical or medical procedure. Documents and communicates information to consumers, including answering inbound calls, emails, or chats; and placing outbound follow up calls, emails or chats and/or responding to consumers emails or voicemails in a timely manner. Promotes SmartShopper products and services, influencing consumer use of I&E's products and new program initiatives. Researches, analyzes, and reports any issues related to a member incentive inquiry to the appropriate I&E team, including communicating to the consumer what is being done to resolve the incentive inquiry. Utilizes internal databases to run reports on consumer claim history, procedure code matching, accounts on hold, incentive check fulfillment status, claim load schedule, shopping confirmation codes, exception payments, and consumer shopping search history. Collaborates with the respective departments within ME&T to identify inquiry trends and to help assist with defining the issue and developing a corrective action plan. Corresponds with consumer's health insurance carriers to obtain, validate, and confirm accurate claim status information, or consumer program eligibility status. Calling members' site of service as needed to confirm status of insurance claims. Monitors, documents, and maintains the accurate status for all related inqui