+----------------------------------:+-----------------------------------+ | DESCRIPTION | Scope: | | | This is a critical position | | | requiring excellent customer | | | interaction skills. Individual is | | | 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. | | | | | | 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. | | | | | | Knowledge, Skills and | | | Abilities | | | | | | - Strong customer relations, | | | interpersonal skills. | | | | | | {=html} | | | | | | | | | - Strong appreciation and | | | ability to handle | | | confidential and sensitive | | | information. | | | - 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. | | | | | | {=html} | | | | | | | | | - 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 and | | | anticipate potential | | | needs/problems. | | | - Ability to build | | | relationships with internal | | | and external customers. | | | - Strong attention to detail. | | | | | | {=html} | | | | | | | | | - Understanding of Self-Funded | | | health benefits a plus. | | | - Health Payor background | | | preferable in self-funded | | | industry a plus | | | | | | {=html} | | | | | | | | | - 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 | | | - Bilingual a plus | | | | | | Education: Associates Degree | | | or higher preferred but not | | | required, Minimum High School | | | Diploma or G.E.D. | | | | | | | |