Provider Escalation & Resolution Specialist

Zelis; Saint Petersburg (FL); On-site; USD 52,000 - 70,000; Full time

Job summary

Zelis is seeking a Provider Escalation & Resolution Specialist in Saint Petersburg, FL to deliver exceptional customer service. You will be the first touchpoint for clients, addressing inquiries, resolving issues, and maintaining accurate client records.

The role requires coordinating with internal teams, staying updated on Zelis products, and contributing to service improvements. Ideal candidates have healthcare exposure, experience with escalation tickets, and strong communication skills.

Qualifications

• Healthcare experience is helpful.
• Experience with healthcare escalation tickets preferred.
• Troubleshoot ticket-related issues and provide timely resolutions.
• Proficiency using AI tools and prompts.
• Excellent written and verbal communication skills.
• Strong problem-solving and conflict resolution abilities.
• Ability to work independently and in a team.

Responsibilities

• Respond to client inquiries via phone, email, and in person meetings.
• Provide accurate information about products, services, and policies.
• Resolve client issues and ensure customer satisfaction and retention.
• Manage client accounts and keep information up to date.
• Conduct regular check-ins with clients to assess needs and satisfaction.
• Escalate complex issues to higher-level support or management as needed.
• Follow up to confirm issues are resolved and clients are satisfied.
• Maintain detailed records of client interactions and transactions.
• Prepare regular reports on inquiries, issues, and resolutions.
• Identify trends and provide feedback to improve processes and services.

Skills

Healthcare experience

Escalation tickets

AI tools proficiency

Written communication

Verbal communication

Problem solving

Teamwork

Microsoft Office

CRM software

Tools

CRM systems

Microsoft Office

Job description

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:

• 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.