Concierge Customer Service Representative II

MedWatch, LLC; Town of Florida (NY); Hybrid; USD 26,000 - 28,000; Full time

Job summary

MedWatch, LLC is seeking a Senior Concierge/Customer Service Floater to provide expert support to members and providers on health benefits, precertification, and plan questions. You will handle calls, emails, and case status, ensuring accurate information and a high level of customer care.

The role requires strong communication, data entry, and confidentiality, with opportunities to work across Concierge and Intake teams.

Qualifications

• Two years of health care customer service or call center experience.
• Medical intake experience a plus.
• High school diploma or GED required.
• Associate degree or higher preferred.

Responsibilities

• Respond to telephone and email inquiries 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 in the system.
• Handle precertification calls and provide case status and contact numbers.
• Make outgoing calls for information and redirection as needed.
• Complete incoming electronic Web-certs.
• Verify patient and provider demos and correct as needed.

Skills

Customer relations

Interpersonal skills

MS Office proficiency

Data entry

Healthcare knowledge

CMS Medicare familiarity

Negotiation

Bilingual

Education

Associate degree or higher preferred

Job description

Scope:

This is a critical senior level customer service position requiring excellent customer interaction skills along with critical thinking. This individual is expected to accurately service and satisfy customers by responding to customer inquiries regarding health benefits including precertification based on the employer’s / Third Party Administrator’s contract with MedWatch. Concierge/Customer Service Representative Floater needs to be versatile and equipped with a strong skill set to handle the complexity of the job and the ability to assist callers in both the Concierge and Intake departments.

Duties and 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.

Knowledge, Skills and Abilities:

• Strong customer relations, 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.
• 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.
• Strong analytical and research skills
• Bilingual a plus

Education:

• Associate degree or higher preferred but not required, Minimum High School Diploma or G.E.D.

Experience:

• Two Years Customer Service / Call Center experience in a health care related role.
• Medical Intake experience a plus

The pay range for this position is $19.00 to $20.00 hourly.

Work Environment / Physical Demands

This position is in a typical office/home office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment. May have occasional high stress when dealing with customers/clients.

We are an Equal Opportunity Employer, including disability/veterans.