Concierge Customer Service Representative II

🕒 June 24

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MedWatch, LLC

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1988

⚕️ Healthcare Insurance

🤝 B2B

Healthcare Insurance • B2B

MedWatch, LLC is a healthcare services company that provides utilization management, case management, disease management, member advocacy and concierge care coordination to payers, TPAs, and self‑insured employers. For over 35 years it has delivered clinically driven care management, precertification and claims solutions, direct contracting and ancillary services backed by URAC accreditations and proprietary in‑house technology to improve clinical outcomes and reduce plan and member costs.

📋 Description

• 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. • Handle 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-certs. • Verify patient and provider demos – correct and/or complete when needed.

🎯 Requirements

• Strong customer relations, interpersonal skills. • Strong appreciation and ability to handle confidential & sensitive information. • Proficient with Microsoft applications, strong computer skills and computer navigation. • Excellent data entry and typing skills. • 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. • 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 a plus. • Provider office/facility billing department or financial area. • TPA experience a plus. • Strong analytical and research skills. • Bilingual a plus

🏖️ Benefits

• paid time off • medical • dental • vision • short and long-term disability • life insurance • AD&D • 401k with match • critical illness coverage • legal plan • identity theft coverage • pet insurance • discount programs