Sagility Accounts Line of Business (LOB) Descriptions

1. Healthcare

• The Healthcare LOB focuses on providing end-to-end support to healthcare payers, providers, and members. Services include claims processing, member and provider support, prior authorization, benefits verification, and care management. The goal is to enhance operational efficiency and improve member satisfaction through accurate and timely healthcare solutions.

2. PCC (Provider Contact Center)

• The PCC LOB handles inbound and outbound communication with healthcare providers. Representatives assist with provider inquiries related to claims, authorizations, eligibility, payment status, and network participation. The focus is on delivering accurate information, resolving issues efficiently, and maintaining positive provider relationships.

3. HAP (Health Alliance Plan)

• The HAP process deals with servicing members and providers associated with the Health Alliance Plan. Responsibilities include assisting members with benefits, claims, coverage, and enrollment, ensuring compliance with HIPAA standards, and supporting the payer’s operational goals with high-quality customer service.

4. Dental

• The Dental LOB manages insurance-related services for dental care, including claims adjudication, benefits verification, and provider/member inquiries. The process ensures timely and accurate resolution of dental claims, adherence to policy guidelines, and quality communication with both providers and members.

5. BSC (Blue Shield of California)

• This process supports Blue Shield of California operations by handling member and provider interactions, claims support, eligibility verification, and issue resolution. The focus is on compliance, accuracy, and member satisfaction, aligned with BSC’s mission to provide accessible and affordable healthcare.

6. PPI (Provider/Payment Integrity)

• The PPI LOB ensures accuracy in payments and claim integrity by auditing claims, detecting overpayments or inconsistencies, and validating compliance with payer policies. It helps reduce financial leakage and supports regulatory adherence, safeguarding both payer and provider interests.

Requirements:

• College graduate with or without BPO experience
• Open for 2-year graduate or undergraduate (completed) with 6 months work experience
• Good communication skills

Other benefits:

• 20k Sign On Bonus
• 20% Night differential
• HMO coverage for employee upon Day 1 and HMO dependent upon certification
• Life and Accident Insurance
• Annual increase based on performance
• 13 and 14th month Pay
• retirement plan
• Virtual interview via msteams ( Final interview only 1 day process )