Concierge Customer Service Representative II

This is a fully remote position, open to applicants in United States.

📋 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 with out-of-network providers.

• Assist members with inquiries regarding benefits and healthcare.

• Record all incoming calls in a system-based call log.

• Manage all incoming MedWatch precertification calls (including starting cases, maintaining call logs, redirecting calls, providing case status, and claims phone numbers, etc.).

• Initiate outgoing calls for MedWatch (such as demos, information for case completion, or redirection for network steerage, etc.).

• Complete incoming electronic Web-certs.

• Verify patient and provider demos, correcting and/or completing them when necessary.

⛳️ Requirements

• Strong customer relations and interpersonal skills.

• High regard for and adeptness in handling confidential and sensitive information.

• Proficient in Microsoft applications with strong computer skills and navigation abilities.

• Excellent data entry and typing proficiency.

• Familiarity with provider organizations and networks.

• Knowledge of CMS Medicare reimbursement rates.

• Capability to effectively negotiate rate structures.

• Patience and skill in managing challenging situations with tact and diplomacy.

• Initiative in resolving issues and completing project-related tasks.

• Outstanding verbal and written communication abilities.

• Independent judgment in decision-making and problem-solving.

• Proficient in multi-tasking and anticipating potential needs or problems.

• Ability to cultivate relationships with both internal and external customers.

• Understanding of medical terminology.

• Strong attention to detail.

• Familiarity with Self-Funded health benefits is a plus.

• Experience in the health payor sector, preferably within the self-funded industry, is advantageous.

• Skills in claim processing are a plus.

• Experience in insurance verification or pre-certification is beneficial.

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

• TPA experience is an added advantage.

• Strong analytical and research capabilities.

• Bilingual proficiency is a plus.

🏝️ Benefits

• Paid time off

• Medical

• Dental

• Vision

• Short and long-term disability

• Life insurance

• AD&D

• 401k with match

• Critical illness coverage

• Legal plan

• Identity theft coverage

• Pet insurance

• Discount programs