Concierge Customer Service Representative II

Scope

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

• Respond to telephone and email inquiries received 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 received in system‑based call log.
• Handle all incoming Med Watch precertification calls (e.g., start cases, create call logs, forward calls, provide case status, provide claims phone numbers).
• Make outgoing Med Watch calls for demos, case completion information, and network steerage.
• Complete incoming electronic Web‑certifications.
• Verify patient and provider demographics—correct and/or complete when needed.

• Strong customer relations and interpersonal skills.
• Ability to handle confidential and sensitive information.
• Proficiency with Microsoft applications and strong computer navigation skills.
• Excellent data entry and typing skills.
• Knowledge of provider organizations and networks.
• Knowledge and understanding of CMS Medicare reimbursement rates.
• Ability to negotiate rate structures effectively.
• Patience and ability to handle difficult situations tactfully and diplomatically.
• Initiative to resolve situations and accomplish project actions and tasks.
• Excellent verbal and written communication skills.
• Independent judgment in decision making and problem solving.
• Ability to multi‑task and anticipate potential needs/problems.
• Ability to build relationships with internal and external customers.
• Knowledge of 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 experience (a plus).
• Experience in provider office/facility billing department or financial area.
• TPA experience (a plus).
• Strong analytical and research skills.
• Bilingual (a plus).

• Associate degree or higher preferred but not required; minimum high school diploma or G.E.D.

• Two years of 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.

This position is in a typical office/home office environment that requires prolonged sitting in front of a computer. The role requires hand‑eye coordination and manual dexterity sufficient to operate standard office equipment, including computers and phone systems. Occasional high stress may occur when dealing with customers/clients.

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