Job description

About the Organization

This company operates within the healthcare insurance sector, specifically focusing on dental and vision insurance plans. It addresses the challenges customers encounter related to eligibility, benefits coverage, and claims handling through dedicated support services. The program manages a wide array of inquiries assisting both plan members and providers, fostering customer satisfaction and maintaining strong provider relationships.

Position Overview

The Customer Care Representative II role requires delivering clear, empathetic, and effective assistance to individuals seeking help with their dental and vision insurance benefits. The incumbent plays a vital role in responding to member and provider inquiries, supporting enrollment processes, and facilitating communication between providers and Member Services. This role ensures customers receive precise information and provider concerns are handled promptly, enhancing service quality and operational efficiency.

Primary Duties

Attend inbound calls related to eligibility, benefit details, authorizations, claims, and provider location assistance for dental and vision plans.
Address provider requests concerning claim corrections and resubmissions.
Communicate complex claim issues to Provider Relations to guarantee prompt resolution.
Assist with enrollment responsibilities such as assigning primary care providers and updating insurance data.
Act as a liaison between the organization and Member Services to resolve eligibility problems and handle appeals or grievances.
Update providers regarding credentialing application progress.
Guide providers on how to utilize the online portal for frequent inquiries.
Ensure all interactions comply with company and client quality standards.
Precisely document call information and resolutions in internal tracking systems.
Utilize effective communication techniques to make customers feel acknowledged and supported.
Identify and escalate issues to leadership when necessary.
Advocate for system and process enhancements.
Inform Provider Relations of any discrepancies or changes impacting providers.
Engage in departmental projects as required.

Qualifications

High school diploma or an equivalent credential.
At least one year of customer service experience, preferably in healthcare, call centers, banking, or retail sectors.
Basic skills in Microsoft Office applications such as Word, Excel, and Outlook.
Willingness to work occasional overtime hours.
Excellent listening, communication, and empathy abilities.
Skilled in data entry and typing with high accuracy.
Strong multitasking and navigation capability.
Exceptional attention to detail.
Capable of critical thinking to analyze requests and provide appropriate resolutions.
Preferred experience includes one or more years in customer service within dental, vision, or medical insurance environments.
Experience working in a virtual or remote setting is advantageous.
Familiarity with terminology related to dental, vision, or medical insurance is a plus.

Compensation Information

The salary and benefits package will be determined based on the candidate's experience, skill set, and other relevant criteria.

Benefits and Work Schedule

An additional $2.00 per hour premium is offered on Mondays and Tuesdays.
This role is 100% remote.
Initial training runs from 8:00 am to 4:30 pm CST for twelve weeks.
Post-training work hours are from 10:30 am to 7:00 pm CST, Monday through Friday.
There may be occasional evening, weekend, and holiday shifts required during the Annual Medicare Open Enrollment period (October 1 to March 31).
This position offers opportunities for career advancement within a fulfilling environment.

Equal Opportunity Statement

The employer is committed to equal employment opportunities and embraces workplace diversity. All qualified applicants will be considered without discrimination based on race, color, religion, gender identity or expression, sexual orientation, or national origin.

Customer Care Representative II - Fully Remote