About The Position

This is a critical position requiring excellent customer interaction skills. This individual is expected to accurately service and satisfy customers by responding to customer inquiries, communicate benefit and healthcare questions/answers in both Spanish and English. Concierge Customer Service Representatives needs to be versatile and equipped with a strong skill set to handle the complexity of the job.

Requirements

  • Customer Service / Call Center experience
  • Strong customer relations, interpersonal skills.
  • Strong appreciation and ability to handle confidential & sensitive information.
  • Individual must speak fluent English and Spanish with strong reading and writing abilities in each language.
  • Proficient with Microsoft applications and computer navigation.
  • 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.
  • Strong attention to detail.
  • Strong computer skills
  • Strong analytical and research skills
  • Good organizational skills and time management
  • Excellent verbal and written communication skills
  • Ability to handle difficult situations tactfully and diplomatically.
  • Effective problem solving and decision-making skills.
  • Strong computer skills with proficiency in MS Office Suite products (Word, Excel, PowerPoint)

Nice To Haves

  • Understanding of Self-Funded health benefits a plus.
  • Health Payor background preferable in self-funded industry a plus
  • Claim processing skills a plus.
  • Insurance verification or pre-certification a plus
  • Provider office/facility billing department or financial area
  • TPA experience a plus.

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.
  • The incumbent may be responsible for duties or responsibilities that are not listed in this job description. Duties and responsibilities may change at any time with or without notice.
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