Job Details

Scope:

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.

Education:

• Associate degree or higher preferred but not required.

• Minimum High School Diploma or G.E.D.

Experience:

• Customer Service / Call Center experience

Requirements/Skills:

• 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.

• 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 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)

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.

• 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 rate for this position is $17.00 to $19.00 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.