Concierge Customer Service Representative II

This opportunity is offered by a reputable organization specializing in health benefits administration and customer service, specifically focusing on supporting members and providers with essential health benefit inquiries and precertification processes. The company is recognized for its commitment to delivering quality service through skilled communication and thorough problem-solving across intricate healthcare service aspects. Positioning itself in the healthcare payor industry, this employer operates with a sophisticated approach to navigating complex healthcare plans, including Medicare and self-funded benefits, while upholding confidentiality and compliance.

The role available is a senior-level Concierge/Customer Service Representative Floater position, pivotal in managing high-level customer interactions and ensuring exceptional service standards. This full-time role is designed for professionals adept at multitasking and capable of handling diverse responsibilities associated with both Concierge and Intake department functions. It emphasizes a client-focused mindset, critical thinking, and the capacity to manage sensitive and complex healthcare information. Employees in this position engage directly with members and healthcare providers, facilitating inquiry responses, precertification activities, and negotiation with out-of-network providers to enhance plan accessibility for members.

Pay for this role ranges between $19.00 and $20.00 per hour, reflective of the critical expertise and experience required. The workspace typically includes both traditional office and home office environments, demanding prolonged computer use, strong hand-eye coordination, and the ability to manage high stress when handling client interactions. Key responsibilities include addressing incoming telephone and email inquiries within established service standards, managing MedWatch precertification calls with precision, documenting all interactions thoroughly, negotiating with providers, and verifying patient and provider information.

The position also requires proficiency in Microsoft applications, excellent data entry, verbal and written communication skills, and the ability to maintain confidential information. Knowledge of medical terminology, healthcare provider networks, CMS Medicare reimbursement rates, and health payor industry practices is beneficial. Experience in insurance verification, pre-certification, claim processing, and TPA environments is considered advantageous. This role necessitates independent judgment, strong analytical abilities, and diplomacy in resolution management, promoting a seamless customer service experience for all stakeholders.

Ideal candidates will have at least a high school diploma or GED, though an associate degree or higher is preferred. A minimum of two years' experience in customer service or call center roles within healthcare settings is essential. While bilingual candidates and those with medical intake experience are highly desired, the employer places significant emphasis on candidates who can navigate complex healthcare conversations, negotiate effectively, and maintain meticulous attention to detail. Equal opportunity employment practices are firmly upheld, including accommodations for individuals with disabilities and veterans. The organization prides itself on fostering a professional and supportive environment where customer satisfaction and operational excellence go hand in hand.