[Remote] Concierge Customer Service Representative II

Note: The job is a remote job and is open to candidates in USA. MedWatch, LLC is seeking a Concierge Customer Service Representative II to provide 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 healthcare questions.ResponsibilitiesRespond to telephone and email inquiries received from members and provider within defined service standardsNegotiate with providers to gain acceptance for plans without network agreements and/or out of network providersAssist members with benefits and healthcare questionsDocument all calls received in system-based call logHandle 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-certsVerify patient and provider demos – correct and/or complete when neededSkillsExcellent customer interaction skillsCritical thinking skillsAbility to accurately service and satisfy customersRespond to telephone and email inquiries received from members and providers within defined service standardsNegotiate with providers to gain acceptance for plans without network agreements and/or out of network providersAssist members with benefits and healthcare questionsDocument all calls received in system-based call logHandle all incoming MedWatch precertification callsMake outgoing calls for MedWatchComplete incoming electronic Web-certsVerify patient and provider demosStrong customer relations and interpersonal skillsStrong appreciation and ability to handle confidential & sensitive informationProficient with Microsoft applicationsStrong computer skills and computer navigationExcellent data entry and typing skillsKnowledge of provider organizations and networksKnowledge and understanding of CMS Medicare reimbursement ratesAbility to effectively negotiate rate structuresPatience and ability to handle difficult situations tactfully and diplomaticallyTakes initiative to resolve situations and to accomplish projects actions and tasksExcellent verbal and written communication skillsIndependent judgment in decision making and problem solvingAbility to multi-task & anticipate potential needs/problemsAbility to build relationships with internal and external customersMedical TerminologyStrong attention to detailMinimum High School Diploma or G.E.DTwo Years Customer Service / Call Center experience in a health care related roleAssociate degree or higherUnderstanding of Self-Funded health benefitsHealth Payor background preferable in self-funded industryClaim processing skillsInsurance verification or pre-certificationProvider office/facility billing department or financial areaTPA experienceStrong analytical and research skillsBilingualCompany OverviewSince 1988, MedWatch has been a leader in providing concierge member advocacy and medical cost containment solutions for TPAs, employer groups, school systems, municipalities, hospital systems, Taft-Hartley plans, and fully insured payers as well as for the reinsurance industry and stop loss carriers. It was founded in 1988, and is headquartered in Lake Mary, Florida, USA, with a workforce of 201-500 employees. Its website is https://www.urmedwatch.com/home/.