Customer Service Representative

Job Description

Job Description

POSITION SUMMARY:  Responds to questions from members, groups, and dental offices regarding products and plans.  This position requires resolution of problems with claims, complaints and appeals with dentists, and group enrollment. Works with a wide variety of internal resources to resolve issues to ensure customer satisfaction.

Essential Functions:

• Responds to current and prospective customer questions and complaints/appeals in a timely and empathetic manner via telephone or web inquiries
• Researches of complaints, appeals, claims, processing issues, benefit and eligibility requests and all communication with external and internal customers
• Collaborates with Operations to review claims and decisions regarding payment
• Answers inquiries from dental offices to clarify coverage levels, identifies allowable procedures, and resolves claims payment issues 
• Builds a strong rapport with dental office staff, groups and members to ensure a positive perception of the company within the community
• Performs other duties as assigned

Requirements: 

• High school diploma or equivalent, college degree preferred
• Previous customer contact experience (i.e. customer call center, dental office experience, or experience within a similar insurance system)
• Medical or dental insurance experience, dental office or clinical assistant experience a plus
• Excellent communication skills (verbal and written)
• Attention to detail and accuracy essential

Work Environment / Physical Demands:

• Typical office environment