This is a Fully Remote Job
About Our Client:
The organization operates within the specialty benefits sector, serving payers and government agencies that manage dental and vision benefits. It addresses challenges in delivering and administering these benefits by providing technology and service solutions designed to enhance the efficiency and effectiveness of healthcare organizations.
About the Opportunity:
The CUSTOMER CARE REP II role is focused on delivering high-quality customer service to members and providers related to dental and vision insurance. This position is responsible for resolving inquiries about eligibility, coverage, claims, and provider locations, contributing to improved customer experience and operational effectiveness during and beyond the Medicare Annual Open Enrollment period.
Responsibilities:
- Handle inbound calls regarding dental and vision benefit eligibility, coverage, authorizations, claims, and provider information.
- Use knowledge of claim adjustments and resubmission to resolve provider requests.
- Communicate high-level claim issues to Provider Relations for timely resolution.
- Support enrollment tasks, including assigning primary care providers and updating insurance information.
- Liaise with client Member Services to resolve eligibility and appeals issues.
- Provide credentialing application status updates to providers.
- Educate providers on using the web portal for common inquiries.
- Ensure calls meet company and client standards.
- Accurately document calls and resolutions.
- Apply de-escalation techniques to support customer satisfaction.
- Identify and escalate issues to leadership as needed.
- Recommend system and process improvements to management.
- Keep Provider Relations updated on provider-related issues.
- Participate in departmental projects as applicable.
Requirements:
- High school diploma or equivalent.
- At least one year of customer service experience in healthcare, call center, banking, or retail.
- Basic proficiency with Microsoft Office (Word, Excel, Outlook).
- Ability to work occasional overtime.
- Strong listening and communication skills.
- Empathy and superior customer service ability.
- Strong data entry, typing, navigation, multitasking, and attention to detail.
- Critical thinking to analyze and meet customer needs.
Preferred:
- One year or more customer service experience in dental, vision, or medical insurance.
- Experience working remotely.
- Understanding of dental, vision, and 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.
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:
TalentHop 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.