• Responds to inbound calls from health plans, employer groups, employees, and family members within 30 seconds, delivering exceptional, professional support in a timely, courteous, and energetic manner to members planning an elective surgical or medical procedures. • Accurately documents and communicates consumer interactions, including handling inbound calls, emails, and chats, as well as conducting outbound follow-up calls and responding promptly to emails and voicemails. • Promotes SmartShopper products and services, encouraging consumer engagement with Zelis offerings and supporting adoption of new program initiatives. • Researches, analyzes, and escalates member incentive inquiries to the appropriate internal team, clearly communicating resolution steps and updates to consumers. • Leverages internal databases to generate reports on claim history, procedure code matching, accounts on hold, incentive check fulfillment status, claim load schedules, shopping confirmation codes, exception payments, and consumer search history. • Communicates with consumers’ health insurance carriers to obtain, validate, and confirm accurate claim status and program eligibility information. • Contacts members’ sites of service, as needed, to verify the status of insurance claims. • Monitors, documents, and maintains accurate records for all related inquiry cases, ensuring proper case assignment and timely resolution by the appropriate individual or team. • Supports digital and direct mail engagement campaigns by interacting with consumers to confirm registration and encourage active participation in SmartShopper program offerings. • Partners regularly with the SmartShopper Staff Development and Quality Management (QM) Specialist to fulfill ongoing education and training requirements, including completing refresher courses and knowledge checks within designated timeframes. • Collaborates with the SmartShopper Staff Development and QM Specialist to meet or exceed QM scorecard targets and maintain high consumer satisfaction ratings in alignment with Zelis and Customer Care standards. • Works closely with the Finance team to verify reward check status and ensure proper documentation and voiding when reissuing incentive payments is necessary. • Applies analytical and problem-solving skills to identify, document, and escalate trends related to member inquiries, complaints, unpaid incentives, and other departmental performance improvement opportunities to leadership. • Communicates with members’ sites of service to research and document billing discrepancies as they arise. • Collaborates with the Data team to support the processing and distribution of reward incentive checks.