Provider Escalation & Resolution Specialist

Zelis Healthcare, LLC; Saint Petersburg (FL); Hybrid; USD 42,000 - 64,000; Full time

Job summary

Zelis Healthcare, LLC seeks a Provider Escalation & Resolution Specialist to deliver exceptional client service and support. You will be the first contact for clients, addressing inquiries, resolving issues, and coordinating with internal teams to ensure a positive experience.

You will handle inquiries via phone, email, and in-person meetings, maintain accurate records, and contribute to improving processes and client satisfaction. Hybrid work arrangement with location flexibility within the U.S.

Qualifications

• 1+ years of customer service experience.
• Healthcare experience is helpful.
• Experience with healthcare escalation tickets is preferred.
• Troubleshoot ticket-related issues and provide timely resolutions.
• Proficiency with AI tools and creating prompts/agents.
• Excellent written and verbal communication.
• Strong problem-solving and conflict resolution skills.
• Ability to work independently and in a team.
• Proficiency in Microsoft Office Suite and CRM software.

Responsibilities

• Respond to client inquiries via phone, email, and in-person meetings in a timely and professional manner.
• Provide accurate information about products, services, and policies.
• Resolve client issues and complaints to ensure satisfaction and retention.
• Manage client accounts and keep information up-to-date.
• Conduct regular check-ins with clients to assess needs and satisfaction.
• Coordinate with internal departments to investigate and resolve issues.
• Escalate complex issues as needed to higher-level support or management.
• Maintain detailed records of client interactions and transactions.
• Prepare and submit regular reports on inquiries, issues, and resolutions.
• Identify trends and provide feedback to improve processes.

Skills

Customer service

Healthcare experience

Escalation tickets

AI tools prompts

CRM software

Communication skills

Tools

CRM software

Microsoft Office

Job description

At Zelis, we Get Stuff Done. So, let's get to it!

A Little About Us

Zelis is modernizing the healthcare financial experience 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.

A Little About You

You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are.

Position Overview

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.

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

Location and Workplace Flexibility

Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. Check out our locations to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership team. In-office work and activities vary based on work and team objectives in accordance with Company policies.

While location expectations vary by role, candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible, and in-office presence is guided by team and business needs rather than a fixed weekly schedule.

Equal Employment Opportunity

Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email .

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.