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Role Description

Customer Service Representatives will be working directly with the customer to answer general inquiries, address concerns, and assist with requests about products and services across multiple lines of business. The CSR must project a professional company image and provide superior customer service while working with customers through any of the customer contact channels.

• Resolving coordination of benefits inquiries by analyzing patient activity (including enrollment, third party liability, claims attachments).
• Having a comprehensive understanding of insurance coverage and being able to interpret and communicate accurate information.
• Thoroughly and completely documenting all customer interactions.
• Educating customers and dental professionals on eligibility, benefits, claims payment, and authorizations.
• Educating on the usage and benefits of self-service tools.
• Assisting members on gaining access to care by locating a network dentist or assignment to a primary care dentist.
• Directing inquiries to necessary departments or individuals when the resolution of the inquiry is beyond the span of control for this role.
• Responding to customer inquiries in a courteous and professional manner.
• Researching and consistently providing accurate information to resolve all member and provider inquiries through verbal and written communications through all channels including phone, email, web portal, and chat interactions.
• Responding to and resolving internal and external complex customer inquiries.
• Resolving claim payment inquiries by researching and analyzing patient activity and determining appropriate action to be taken.
• Taking ownership of the resolution and setting expectation for follow up.
• Ensuring resubmissions, stop payments, and voids are appropriately handled.
• Meeting or exceeding individual, department, and client specific goals.
• Understanding and adhering to all client administrative and contractual policies and procedures.
• Suggesting ways to improve the service delivery processes contributing to the success of the organization.
• Other duties as assigned.

Qualifications

• High School Diploma or Equivalent
• 2 years experience in a high volume customer service environment
• Experience in healthcare or related industry experience preferred
• Ability to multi-task using multiple applications simultaneously
• Ability to set-up computer equipment and troubleshoot issues with minimal assistance
• Professional verbal and written communication skills
• Ability to operate a computer and knowledge of Microsoft Office applications
• Strong organizational skills and attention to detail
• Ability to work independently and with a team
• Ability to learn quickly and adapt to a fast pace production environment
• Cooperative, professional and effective interaction skills
• Critical thinking and problem solving skills
• Ability to tolerate repetitive work without compromising accuracy and service levels
• Attend additional training as requested/deemed necessary

Requirements

• Medical/Dental terminology knowledge experience preferred
• Medicare/Medicaid knowledge preferred
• Claims/Billing and coding experience preferred

Benefits

• Medical, Dental, and Vision insurance
• 401(k) Retirement Savings Plan
• Paid Time Off
• Paid T-Mobile cell service
• $500.00 Employee referral program
• Employee PerkSpot (discounts on retail, hotel, food, restaurants, car rental and much more!!)