Concierge Customer Service Representative II

MedWatch, LLC is a company focused on providing health benefits support, and they are seeking a Concierge Customer Service Representative II. This senior-level position requires strong customer interaction skills to assist members with health benefits inquiries and manage complex customer service tasks effectively.

Responsibilities:

• Respond to telephone and email inquiries received from members and provider within defined service standards
• Negotiate with providers to gain acceptance for plans without network agreements and/or out of network providers
• Assist members with benefits and healthcare questions
• Document all calls received in system-based call log
• Handle all incoming MedWatch precertification calls (i.e., start cases, do call logs, forward calls, provide case status, provide claims phone #’s, etc.)
• Make outgoing calls for MedWatch (demos, information for case completion, re-direction for network steerage, etc.)
• Complete incoming electronic Web-certs
• Verify patient and provider demos – correct and/or complete when needed

Requirements:

• Excellent customer interaction skills
• Critical thinking skills
• Ability to accurately service and satisfy customers
• Respond to telephone and email inquiries received from members and providers within defined service standards
• Negotiate with providers to gain acceptance for plans without network agreements and/or out of network providers
• Assist members with benefits and healthcare questions
• Document all calls received in system-based call log
• Handle all incoming MedWatch precertification calls
• Make outgoing calls for MedWatch
• Complete incoming electronic Web-certs
• Verify patient and provider demos
• Strong customer relations and interpersonal skills
• Strong appreciation and ability to handle confidential & sensitive information
• Proficient with Microsoft applications
• Strong computer skills and computer navigation
• Excellent data entry and typing skills
• Knowledge of provider organizations and networks
• Knowledge and understanding of CMS Medicare reimbursement rates
• Ability to effectively negotiate rate structures
• Patience and ability to handle difficult situations tactfully and diplomatically
• Takes initiative to resolve situations and to accomplish projects actions and tasks
• Excellent verbal and written communication skills
• Independent judgment in decision making and problem solving
• Ability to multi-task & anticipate potential needs/problems
• Ability to build relationships with internal and external customers
• Medical Terminology
• Strong attention to detail
• Minimum High School Diploma or G.E.D
• Two Years Customer Service / Call Center experience in a health care related role
• Associate degree or higher
• Understanding of Self-Funded health benefits
• Health Payor background preferable in self-funded industry
• Claim processing skills
• Insurance verification or pre-certification
• Provider office/facility billing department or financial area
• TPA experience
• Strong analytical and research skills
• Bilingual