Concierge Customer Service Representative II

📋 Description

• Address telephone and email inquiries from members and providers while adhering to established service standards.

• Negotiate with providers to secure acceptance for plans lacking network agreements and/or those involving out-of-network providers.

• Assist members with inquiries related to benefits and healthcare.

• Record all calls in the system-based call log.

• Manage all incoming MedWatch precertification calls (i.e., initiate cases, maintain call logs, forward calls, provide case status updates, and claims phone numbers, etc.).

• Conduct outgoing calls for MedWatch (including demos, information for case completion, and re-direction for network steerage, etc.).

• Process incoming electronic Web-certs.

• Verify patient and provider demos, correcting and/or completing information as necessary.

⛳️ Requirements

• An associate degree or higher is preferred, though a minimum of a high school diploma or G.E.D. is required.

• Two years of customer service or call center experience in a healthcare-related position.

• Medical intake experience is an advantage.

• Strong interpersonal and customer relations skills.

• High regard for and capability in managing confidential and sensitive information.

• Proficiency in Microsoft applications, along with strong computer skills and navigation abilities.

• Excellent data entry and typing capabilities.

• Familiarity with provider organizations and networks.

• Understanding of CMS Medicare reimbursement rates.

• Competence in effectively negotiating rate structures.

• Patience and the ability to handle challenging situations tactfully and diplomatically.

• Initiative to resolve issues and accomplish project actions and tasks.

• Outstanding verbal and written communication skills.

• Capacity for independent judgment in decision-making and problem-solving.

• Ability to multi-task and anticipate potential needs or problems.

• Skill in building relationships with both internal and external customers.

• Knowledge of medical terminology.

• Strong attention to detail.

• Understanding of self-funded health benefits is a plus.

• Background in health payor, particularly in the self-funded industry, is advantageous.

• Claim processing skills are a plus.

• Experience in insurance verification or pre-certification is an asset.

• Background in provider office/facility billing departments or financial areas.

• TPA experience is a plus.

• Strong analytical and research skills.

• Bilingual capabilities are a plus.

🏝️ Benefits

• Paid time off

• Medical insurance

• Dental insurance

• Vision insurance

• Short and long-term disability coverage

• Life insurance

• Accidental death and dismemberment insurance

• 401k plan with matching contributions

• Critical illness coverage

• Legal plan

• Identity theft protection

• Pet insurance

• Discount programs