Healthcare Member Services Specialist

Job Description

Job Description

Join Our Team & Make a Real Impact!

Do you value meaningful work that truly makes a difference? Are you ready to bring your passion and expertise to a team that cares just as much about each other as we do about our members? If you’re looking for more than just a job - a place to grow, contribute, and be valued - you’ve found it!

At Dental Health Services, collaboration isn’t just a buzzword - it’s how we thrive. As an Employee-Owned company , every team member plays a vital role in shaping our success and delivering outstanding specialized healthcare.

Come be a part of something bigger. Your unique skills, ideas, and dedication will help drive innovative, people-first dental health solutions . Let’s build a healthier future - together.

Job Summary

The Member Services Specialist addresses member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for dental care. Responsible for receiving, responding to, and directing member phone calls, or written questions. Provides available information upon request and research or escalates issues as appropriate. Maintains confidentiality per HIPAA guidelines. 

Essential Responsibilities

• Provides information and guidance in response to telephone inquiries from members, dentists, brokers, and group contacts in a professional and supportive manner.
• Acts as a mediator for members, groups, providers, and others to resolve problems and concerns, and answer questions based upon Dental Health Services company plans, policies and procedures.
• Maintains daily and pending phone logs for maintaining accurate department records and follow ups.
• Assists dental offices and members in verifying and communicating member eligibility. Makes arrangements for member second opinions and authorizes emergency referrals.
• Answer questions members may have regarding treatment and charges.
• Provides plan benefit information to existing members. Assists in keeping all member information updated in data systems.
• Researches files, checks billing and interface with other departments to collect data necessary to respond to inquiries.
• Actively seeks to identify member problems and work to resolve them in a timely manner and confirms caller satisfaction in all interactions.
• Answers, screens, and forwards incoming phone calls to the appropriate person and/or department to ensure high caller service and support
• Performs any and all additional duties as requested and directed for this position.

Basic Qualifications

Experience

• Minimum of 1-2 years of related experience

Education

• High school diploma or equivalent
• Some college preferred

License, Certification, Registration

• N/A

Additional Requirements

• Excellent interpersonal, oral, and written communication skills
• Computer literacy is required
• Well organized
• Detail-oriented

Preferred Qualifications

• Knowledge of dental terminology and procedures
• Bilingual English/Spanish
• Previous experience in a customer service call center

Position Details

• Primary Location: Long Beach, California
• Job Schedule: Full time
• Scheduled Weekly Hours: 40
• Shift: Monday - Friday between the hours of 8:00 am to 6:00 pm, Overtime as needed
• Travel: No

We look forward to having you on our team!