Scope: This is a critical position requiring excellent customer interaction skills. Individuals are expected to accurately service and satisfy customers by responding to customer inquiries. Concierge/Customer Service Representative needs to be versatile and equipped with a strong skill set to handle the complexity of the job.Education: •Minimum HS Diploma/GED, 2 years college or higher education preferred.Licensure/Certification Requirements:•NoneExperience: •One year Customer Service / Call Center experience in a health care related role.•Medical Intake or Third-Party Administrator (TPA) experience preferred.•Bilingual English-Spanish a plus.Requirements/Skills: •Patience and ability to handle difficult situations tactfully and diplomatically.•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. •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.•Claim processing skills a plus.•Insurance verification or pre-certification a plus•Provider office/facility billing department or financial area.•Strong analytical and research skillsDuties 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.•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.The pay range for this position is $16.00 to $18.00.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.Applicants must be authorized to work for any employer in the United States. We are unable to sponsor applicants for employment. We are an Equal Opportunity Employer, including disability/veterans.
