Healthcare Customer Service Representative

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

📋 Description

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

• Explain and clarify dental benefits, policies, and procedures for members, providers, and employer groups.

• Investigate and resolve concerns from members or providers by contacting the relevant parties and accurately documenting interactions in the billing system.

• Address verbal complaints regarding billing, claims, or services provided.

• Forward service failures to the appropriate internal departments for follow-up and resolution.

• Collect and dispatch written correspondence, plan brochures, provider directories, and other printed materials.

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

• Attain assigned individual monthly performance targets.

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

• Execute additional duties as assigned by management.

⛳️ Requirements

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

• Minimum of 1 year of face-to-face customer service experience.

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

• Completion of a customer service assessment and typing test.

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

• Proficiency 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 involving several concrete variables in standardized situations.

• Successful completion of a background check is required.

• Must complete mandatory paid training with 100% attendance.

• Home internet connection with a minimum of 10 Mbps download and 3 Mbps upload speed.

• Ability to connect the work computer directly to the home modem via Ethernet; satellite and wireless internet are not permitted.

• A distraction-free and secure home workspace.

• Competence in navigating 6 systems and averaging 32 calls per day.

🏝️ Benefits

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

• Paid time off accrues after 180 days of employment.

• Paid training program.

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

• Potential bonuses or incentives based on business needs.

• Health insurance coverage.

• Optional dental and vision programs.

• Life and disability insurance.

• Retirement savings plan.

• Paid holidays.

• Paid leave for vacation and/or sick time.

• Opportunities for growth within the healthcare team.