Customer Care Representative

• Training Schedule: Mon- Fri - 8:00am -4:30pm CST - After Training:  Mon – Fri  7:00am – 3:30pm or 8:30am – 5:00pm CST   

• Please know hours of operation are 7:00am - 8:00pm CST so shift could flex based on business need.

• Fully Remote Role

• $17 and Up depending on experience

• $2/hour differential on Mon/Tues

• Exceptional Professional Growth

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 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 -3 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.