Customer Care Rep II - Fully Remote!

Important things YOU should know:

- Fully remote opportunity

- Training schedule 8:00am - 4:30pm Monday – Friday CST for the 1st 12 weeks

- Work schedule (after training): Multiple opportunities available with ranging start times from 7:00am CST to 10:30am CST Mon - Fri.

- 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

- Experience with Dental or Health insurance a preferred plus

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 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 me