Healthcare Customer Service Representative

This is a fully remote position, open to applicants in Kentucky.

📋 Description

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

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

• Investigate concerns raised by members and providers, engage relevant parties, resolve issues, and accurately record 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 correspondence, plan brochures, provider directories, and other printed materials.

• Meet or surpass ACD call-volume and quality-performance targets.

• Achieve assigned individual monthly performance goals.

• Stay updated on Member Services policies, procedures, and dental plan changes.

• Effectively navigate six systems and manage an average of 32 calls per day.

• Carry out additional duties as assigned by management.

⛳️ Requirements

• High school diploma, GED, or college degree is required.

• A minimum of 1 year of face-to-face customer service experience.

• At least 1 year of call center experience is preferred.

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

• Successfully complete a customer service assessment and typing test.

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

• Strong communication skills over the phone.

• Excellent organizational, time management, written and verbal communication, analytical, and problem-solving abilities.

• Capability to handle problems that involve several concrete variables in standardized situations.

• Successful completion of a background check is required.

• Ability to maintain a distraction-free and secure work environment.

• A home internet connection with a minimum of 10 Mbps download and 3 Mbps upload speed is required.

• Must be able to connect the work computer directly to a home modem via Ethernet; satellite and wireless internet are not acceptable.

• 100% attendance is required during the 5-week classroom training and 2-week nesting training.

• Availability to work Monday–Sunday, from 7:30 AM to 11:00 PM EST.

🏝️ Benefits

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

• Paid time off accrues after 180 days of employment.

• Participation in a paid mandatory training program.

• Employer-provided equipment including a computer, monitor, mouse, keyboard, headset, Ethernet cord, and power cables.

• Retirement savings plan offered.

• Paid holidays included.

• Life and disability insurance provided.

• Voluntary dental and vision programs available.

• Opportunity for bonuses or incentives based on business needs.