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.