Healthcare Customer Service Representative

This is a fully remote position, open to applicants in Alaska, +11 more states.

📋 Description

• Address incoming inquiries related to dental benefits, eligibility, claims, appeals, grievances, and provider searches for both Commercial and Medicare plans.

• Deliver consistent interpretation and clarification of dental benefits, policies, and procedures to members, providers, and employer groups.

• Proactively work to resolve member or provider issues by investigating concerns, reaching out to the relevant parties, and accurately documenting all interactions in the billing system.

• Look into verbal complaints regarding billing, claims, or services provided; escalate service failures to the appropriate internal departments for follow-up and resolution.

• Retrieve and distribute written materials, including plan brochures, provider directories, and other printed resources as necessary.

• Meet or surpass established ACD (Automated Call Distribution) system call volume and quality performance objectives.

• Achieve all assigned individual monthly performance targets.

• Maintain up-to-date and comprehensive knowledge of all Member Services policies, procedures, and dental plan developments.

• Carry out additional duties and responsibilities as assigned by management.

⛳️ Requirements

• Successfully pass a customer service assessment and typing test.

• High school diploma, GED, or a college degree.

• A minimum of 1 year of Call Center experience is preferred.

• 1 year of direct customer service experience.

• Familiarity with and prior experience in the Dental, Medical, or Managed Care industry is preferred.

• Must exhibit self-motivation, resourcefulness, attention to detail, accountability, and teamwork skills.

• Strong organizational, time management, written and verbal communication, analytical, and problem-solving skills are essential.

• Proficiency in Microsoft Word, Microsoft Outlook, and Internet Explorer.

• Effective communication abilities over the phone.

• Capability to manage problems involving multiple concrete variables in standardized situations.

• Successful completion of a background check is mandatory for this position.

🏝️ Benefits

• Medical, dental, and vision benefits are available starting on the first day of employment.

• Paid time off begins to accrue after 180 days (approximately 6 months) of employment.