Be part of a Best-in-Class Team

About Legato Health Technologies

Legato Health Technologies helps health insurers transform member and provider experiences through operational excellence, innovation, and digital transformation. With over 25,000 associates worldwide and growing quickly, Legato provides end-to-end clinical and administrative services, data and analytics, technology services, and a Business Process as a Service (BPaaS) offering. Legato has the scale to effectively implement best-in-class processes, global operating models, and drive transformations that help US Health Insurers reduce costs and improve service delivery.

JOB RESPONSIBILITIES

• Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims.
• Analyzes problems and provides information/solutions.
• Operates a PC/image station to obtain and extract information; documents information, activities, and changes in the database.
• Thoroughly documents inquiry outcomes for accurate tracking and analysis.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
• Researches and analyzes data to address operational challenges and customer service issues.
• Provides external and internal customers with requested information.
• Under immediate supervision, receives and places follow-up telephone calls/emails to answer customer questions that are routine in nature.
• Uses computerized systems for tracking, information gathering, and troubleshooting.
• Requires limited knowledge of company services, products, insurance benefits, provider contracts, and claims.
• Seeks, understands, and responds to the needs and expectations of internal and external customers.

QUALIFICATION & EXPERIENCE

• HS diploma or equivalent; up to 1 year of previous experience in an automated customer service environment; or any combination of education and experience, which would provide an equivalent background.
• Able to perform basic job functions with help from co-workers, specialists and managers on non-basic issues.
• Strong English and Spanish oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

To send your resume and apply with our recruiting firm (BMA), click here.

About Legato Health Technologies

Legato Health Technologies helps health insurers transform member and provider experiences through operational excellence, innovation, and digital transformation. With over 25,000 associates worldwide and growing quickly, Legato provides end-to-end clinical and administrative services, data and analytics, technology services, and a Business Process as a Service (BPaaS) offering. Legato has the scale to effectively implement best-in-class processes, global operating models, and drive transformations that help US Health Insurers reduce costs and improve service delivery.

JOB RESPONSIBILITIES

• Responsible for evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries.

Primary duties may include, but are not limited to:

• Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.
• Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.
• Tracks and trends audit results, providing feedback to management.
• Identifies and reports on systemic issues which create ongoing quality concerns.
• Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested.
• Produces other ad hoc reports as requested by internal and external clients.
• Associates at this level conduct routine to complex audits, generally related to one or more functions on one or more systems platform for one or more lines of business.

QUALIFICATION & EXPERIENCE

• Requires a BA/BS degree; 3 years of experience including a minimum of 1 year of related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background.
• Working knowledge of insurance industry and medical terminology, detailed knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines; and ability to acquire and perform progressively more complex skills and tasks in a production environment required.
• Strong English and Spanish oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

About Legato Health Technologies

Legato Health Technologies helps health insurers transform member and provider experiences through operational excellence, innovation, and digital transformation. With over 25,000 associates worldwide and growing quickly, Legato provides end-to-end clinical and administrative services, data and analytics, technology services, and a Business Process as a Service (BPaaS) offering. Legato has the scale to effectively implement best-in-class processes, global operating models, and drive transformations that help US Health Insurers reduce costs and improve service delivery.

JOB RESPONSIBILITIES

• Responsible for serving as the operations point of contact for day-to-day operations, including but not limited to, facilitating issue resolution, meeting goals and targets.

Primary duties may include, but are not limited to:

• Acts as a liaison for both internal and external groups for program initiatives.
• Helps create, launch and drive critical account initiatives and programs.
• Provides inputs to policies and processes impacting the operations.
• Manages the team in the optimal execution of operations activities ensuring that each team member meets / exceeds their goals and metrics on a daily, weekly and monthly basis.
• Coordinates with workforce for staffing requirements and scheduling of agents given leaves, absences and attrition.
• Arranges schedules to meet the service metrics by efficiently handling the forecast and / or spikes in call.
• Prepares reports.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

QUALIFICATION & EXPERIENCE

• Requires a BA/BS degree; 4 years of related experience in a call center environment; or any combination of education and experience, which would provide an equivalent background.
• Strong English and Spanish oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

To send your resume and apply with our recruiting firm (BMA), click here.