Remote Customer Service Representative (Healthcare)

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

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Job Description:

Work From Home | Healthcare Coverage Review Representative

Build Your Career in Healthcare, From the Comfort of Home!

Are you passionate about helping others, solving problems, and making a difference in healthcare? Your next career opportunity could be with Sagility!

At Sagility, we believe every interaction is an opportunity to make healthcare simpler, more accessible, and more personal. We're looking for motivated, detail-oriented professionals with healthcare and customer service experience to join our growing team of Coverage Review Representatives.

In this role, you'll help members, healthcare providers, and medical offices navigate prescription medication coverage, understand benefits, and obtain important information about prior authorizations.

If you enjoy helping people, thrive in a fast-paced environment, and want to build your career with a healthcare industry leader, we want to hear from you!

What Makes This Opportunity Great?

• 100% Remote: Work from home in an eligible U.S. location.
• Weekly Pay: Get paid every week!
• Competitive Compensation: Earn $16.00 per hour during training and nesting, increasing to $16.50 per hour once in production.
• Earn More During Training: Qualify for performance incentives of up to an additional $2.00 per hour during training and nesting, bringing your potential earnings to $18.00 per hour!
• Paid Training: Receive two weeks of structured training followed by two weeks of supported, hands-on nesting.
• Meaningful Work: Help patients and healthcare providers navigate important medication coverage decisions.
• Career Development: Gain valuable experience in healthcare operations, pharmacy benefits, and coverage review.

Performance incentives are based on meeting established quality, accuracy, attendance, and schedule adherence requirements. Additional details will be provided during training.

What You'll Do

As a Coverage Review Representative, you'll serve as a trusted resource for members, healthcare providers, and other healthcare professionals seeking information about prescription medication coverage.

Your daily responsibilities will include:

• Answer inbound calls from members, physicians' offices, and healthcare partners regarding prescription medication benefits and coverage.
• Verify member eligibility and determine medication coverage under applicable healthcare plans.
• Assist callers with understanding medication coverage options and prior authorization requirements.
• Provide updates on prior authorization requests and coordinate with appropriate departments.
• Review medication inquiries, documentation, and requests for additional information.
• Contact healthcare providers to obtain necessary information and support timely resolution.
• Accurately document interactions, update records, and enter information into multiple systems.
• Deliver professional, compassionate, and accurate customer service while meeting established quality and performance expectations.

Your attention to detail and commitment to service will help make a meaningful difference in the healthcare experience.

What You'll Bring to the Team

We're looking for individuals who are dependable, adaptable, comfortable with technology, and committed to delivering exceptional service.

Required Qualifications:

• High school diploma or equivalent.
• At least 6 months of call center experience.
• At least 1 year of experience in healthcare, medical claims, or medical administration.
• At least 1 year of recent continuous employment with a previous employer.
• Working knowledge of medical and healthcare terminology.
• Strong verbal and written communication skills.
• Excellent computer navigation, keyboarding, and data entry skills.
• Proficiency with Microsoft Windows, Microsoft Office, and the ability to learn multiple software applications.
• Strong problem-solving skills, attention to detail, and the ability to multitask.
• Ability to work independently while contributing to a collaborative team environment.
• Ability to manage competing priorities in a fast-paced, performance-driven environment.

Your Work Schedule & Training

Business Hours: Monday–Friday, 7:00 AM–8:00 PM Central Time. Candidates must be available to work an assigned schedule within these hours.

Training Schedule: Monday–Friday, 7:30 AM–4:00 PM Central Time.

Training Program:

• 2 weeks of instructor-led training.
• 2 weeks of supported nesting to help you transition into production.

Important: Full attendance is required during training, and candidates must commit to no planned time off during their first 90 days of employment.

Work From Home Requirements

To be successful in this remote position, you'll need a dedicated, secure workspace and reliable technology.

Internet Requirements:

• Reliable, hardwired internet connection.
• Internet speeds exceeding 25 Mbps download and 10 Mbps upload.
• Ethernet connection required; Wi-Fi and mobile hotspots are not permitted.

Equipment You Will Provide:

• Monitor measuring 19 inches or larger with VGA or HDMI connectivity and the corresponding cable.
• USB wired mouse.
• Ethernet cable long enough to connect directly to your modem or router.
• Optional USB wired keyboard.

Equipment Sagility Provides:

• Workstation (laptop, desktop, or USB boot device, as applicable).
• USB webcam for the BHIVE platform.
• 4-port USB hub.
• USB wired headset with microphone.

Our Virtual Workplace, BHIVE

This position uses BHIVE, a virtual workplace platform designed to support remote team collaboration, communication, productivity, and time tracking.

BHIVE requires an active webcam positioned to provide a continuous profile view of your workspace, including your monitors, keyboard, head, shoulders, and hands throughout the workday.

Candidates must be comfortable working in this camera-enabled virtual environment.

Ready to Make Your Next Career Move?

Your healthcare experience matters. Put it to work in a role where you can help others, develop valuable skills, and grow professionally all while working from home!

Don't wait for the perfect opportunity to find you. Take the next step toward your future with Sagility today!

About Sagility

Sagility is a leading healthcare business process management services provider dedicated to improving the experiences of healthcare members, patients, and providers.

By combining healthcare industry expertise, innovative technology, and compassionate service, we help our clients deliver better healthcare experiences.

At Sagility, our people make the difference. Join a team where your skills, dedication, and commitment to helping others can create a lasting impact.

Your next chapter starts here. Apply today!

Sagility is an Equal Opportunity Employer/Vet/Disability.

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