Healthcare Customer Service Representative

Role Overview

• Respond to inbound inquiries regarding dental benefits, eligibility, claims, appeals, grievances, and provider searches for both Commercial and Medicare plans.
• Provide uniform interpretation and clarification of dental benefits, policies, and procedures to members, providers, and employer groups.
• Actively attempt to resolve member or provider concerns by investigating issues, contacting appropriate parties, and documenting all interactions accurately within the billing system.
• Investigate verbal complaints regarding billing, claims, or services rendered; escalate service failures to appropriate internal departments for follow-up and resolution.
• Retrieve and send written correspondence, including plan brochures, provider directories, and other printed materials as needed.
• Meet or exceed established ACD (Automated Call Distribution) system call volume and quality performance goals.
• Achieve all assigned individual monthly performance metrics.
• Maintain current and thorough knowledge of all Member Services policies, procedures, and dental plan updates.
• Perform additional duties and responsibilities as assigned by management.

Requirements

• Successfully complete customer service assessment & typing test.
• High school diploma, GED, or college degree
• At least 1 year of Call Center experience preferred.
• 1 year of face-to-face customer service experience.
• Knowledge of and prior experience in the Dental, Medical or Managed Care industry is preferred.
• Must possess the following characteristics: self-motivation, resourceful, detail-oriented, sense of accountability and must be a team player.
• Must possess strong skills in the following areas: organizational, time management, written and verbal communication, analytical, and problem solving.
• Proficiency in Microsoft Word, Microsoft Outlook, and Internet Explorer.
• Effective communication skills over the phone.
• Ability to deal with problems involving several concrete variables in standardized situations.
• Successful completion of background check is required for this position.

Benefits

• Medical, dental and vision benefits are available on the 1st day of employment.
• Paid time off is accrued after 180 days (about 6 months) of employment.