Remote Healthcare Customer Service Representative

Job Description

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.

RESPONSIBILITIES

• 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.

Are you interested in this position?

Apply by clicking on the “Apply Now” button below!

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