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.
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 self-motivation, resourcefulness, detail-oriented nature, sense of accountability and be a team player.
Must possess strong organizational, time management, written and verbal communication, analytical, and problem solving skills.
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.
Benefits
Medical, dental and vision benefits are available on the 1st day of employment.
Paid time off is accrued after 180 days (about 6 months) of employment.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
customer service assessmenttypingbilling systemperformance metricsproblem solvinganalytical skills
Soft skills
self-motivationresourcefulnessdetail-orientedaccountabilityteam playerorganizational skillstime managementwritten communicationverbal communication