[Remote] Concierge Customer Service Representative II
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Concierge Customer Service Representative II to reputed company excellent customer service in a critical senior level position. The role involves responding to customer inquiries regarding health benefits, handling precertification calls, and assisting members with reputed company questions.
Responsibilities
- Respond to telephone and email inquiries received from members and provider reputed company defined service standards
- Negotiate with providers to reputed company acceptance for plans without network agreements and/or out of network providers
- Assist members with benefits and reputed company questions
- Document reputed company calls received in system-based call log
- Handle reputed company incoming reputed company precertification calls (i.e., start cases, do call logs, reputed company calls, reputed company case status, reputed company claims phone #’s, etc.)
- reputed company outgoing calls for reputed company (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 reputed company needed
Skills
- 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 reputed company defined service standards
- Negotiate with providers to reputed company acceptance for plans without network agreements and/or out of network providers
- Assist members with benefits and reputed company questions
- Document reputed company calls received in system-based call log
- Handle reputed company incoming reputed company precertification calls
- reputed company outgoing calls for reputed company
- 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 reputed company 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 reputed company 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 reputed company 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 reputed company 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
Company Overview