Customer Care Representative I

Important things YOU should know:

• Fully remote opportunity
• Training schedule (Initial 90 days) : 8:00am - 4:30pm Monday - Friday CST
• Work schedule (after training): 10:30am - 7:00pm Monday - Friday CST
• Hours of operation: 7:00am - 10:00pm CST Monday - Friday so shift could flex based on business need
• $2.00/hour differential on Mon/Tues
• Occasional evenings, weekends and holidays possible during Annual Medicare Open Enrollment: 10/1 - 3/31
• Exceptional professional growth in a fun rewarding environment

What will YOU be doing for us?

Our Customer Service Representatives must have strong problem-solving skills, coupled with the natural ability to provide empathy for the customer - always taking the time to patiently listen and understand their questions to help find a viable solution, while providing them with a memorable customer experience.

What is in it for YOU?

• Career growth in an inclusive culture
• Paid training
• Health benefits
• 401(k)

What will YOU be working on every day?

• Servicing our Dental and Vision inbound callers with information regarding their eligibility, benefit coverage, authorizations, claims, and assisting them with locating a provider in their area,
• Utilize knowledge of claim adjustments and resubmission processes to determine appropriate resolution to provider requests.
• Provide feedback to Provider Relations staff on high-level claim issues including but not limited to issues with reimbursement schedules or conflicting information to ensure providers receive a prompt resolution.
• Support enrollment activities including but not limited to assigning primary care providers, and updating third party insurance information.
• Act as liaison between our organization and the client's Member Services staff to resolve issues such as eligibility and filing appeals and grievances.
• Provide updates to providers with questions regarding the status of their credentialing application.
• Recognize provider questions that could be handled through the use of the provider web portal and provide education to these callers on the benefits of utilizing the technology available.
• Ensure all calls are answered according to company and client guidelines.
• Accurately document call information and resolution in our internal systems.
• Apply effective diffusion techniques when necessary to ensure our customers feel heard, valued and supported.
• Properly identify issues that need to be escalated appropriately to the leadership team.

Additional Responsibilities:

• Provide recommendations on system enhancements and process improvements to management.
• Keep our Provider Relations team updated with provider manual discrepancies, change in locations or any other provider related issues.
• Participate in departmental projects when applicable.

What qualifications do YOU need to have to be GOOD candidate?

• Required Level of Education, Licenses, and/or Certificates
  • High school diploma or equivalent.
• Required Level of Experience
  • 1+ years of job related customer service experience within industries such as healthcare, call center, banking or retail.
• Required Knowledge, Skills, and Abilities
  • Basic knowledge of Microsoft Office products including but not limited to Word, Excel, and Outlook.
  • Ability to work occasional overtime as needed.
  • Excellent listening and communication skills.
  • Superior customer service skills including the natural ability to provide empathy.
  • Strong data entry/typing skills.
  • Strong navigation skills and the ability to multi-task.
  • Excellent attention to detail.
  • Critical thinking skills to quickly analyze and clearly understand a specific request or customer need and then leverage knowledge and resources to provide the appropriate solutions.

What qualifications do YOU need to be a GREAT candidate?

• Preferred Level of Experience
  • 1+ years of job related customer service experience within the dental, vision or medical industry.
  • Previous experience working in a virtual environment.
  • Understanding of dental, vision and/or medical insurance terminology.