About Our Client:
SKYGEN partners with specialty benefits payers and government agencies to manage dental and vision benefits delivery and administration. The organization addresses challenges in healthcare benefits administration by providing technology and service solutions aimed at improving efficiency and effectiveness in healthcare organizations.
About the Opportunity:
The CUSTOMER CARE REP II role involves directly supporting customers by addressing inquiries related to dental and vision benefits. This position is responsible for delivering accurate information, resolving issues, and facilitating communication between providers and member services. The role contributes to a smooth customer experience and supports the organization's operational success.
Responsibilities:
- Handle inbound calls regarding eligibility, benefit coverage, authorizations, claims, and provider location assistance
- Resolve provider requests using knowledge of claim adjustments and resubmission processes
- Provide feedback to Provider Relations on claim issues affecting reimbursement and information accuracy
- Support enrollment activities including assigning primary care providers and updating insurance information
- Liaise with client Member Services to resolve eligibility issues and manage appeals and grievances
- Update providers on credentialing application status
- Educate providers on using the provider web portal for common inquiries
- Ensure call handling meets company and client standards
- Document call details and resolutions accurately in internal systems
- Apply de-escalation techniques to maintain positive customer interactions
- Identify and escalate issues requiring leadership attention
- Recommend system and process improvements to management
- Communicate provider-related updates to Provider Relations
- Participate in departmental projects as needed
Requirements:
- High school diploma or equivalent
- Minimum 1 year customer service experience in healthcare, call center, banking, or retail
- Basic proficiency with Microsoft Word, Excel, and Outlook
- Ability to work occasional overtime
- Strong listening, communication, and customer service skills with empathy
- Accurate data entry and typing skills
- Proficient in multitasking and navigating computer systems
- Detail-oriented with critical thinking to assess and address customer needs
Preferred:
- Customer service experience in dental, vision, or medical insurance
- Experience in a virtual work environment
- Familiarity with dental, vision, or medical insurance terminology
Pay Range and Compensation Package:
- The pay range and compensation package for this role will be determined based on the candidate's experience, skills, and other relevant factors.
Benefits & Perks:
- $2.00/hour differential on Mondays and Tuesdays
- Fully remote work opportunity
- Training schedule Monday to Friday, 8:00 am to 4:30 pm CST for first 12 weeks
- Flexible work schedule options after training with start times between 6:00 am and 10:30 am CST
- Potential for occasional evening, weekend, and holiday work during Medicare Annual Open Enrollment (October 1 to March 31)
- Opportunities for professional growth
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.