Customer Service Specialist

Job Description

Job Description

Culture rules at Delta Dental. It's key to our becoming the leading dental benefits carrier in the state, reaching over 500,000 Idahoans with our dental plans and community outreach programs. We're small on ego and big on grins. You'll see us involved in community events and "Did you make someone smile today?" on our To-Do lists. Our employees have the opportunity to make a difference in people's lives while working in an environment full of challenge, collaboration, flexibility, and industry-leading growth potential. Join our team committed to better oral health for all Idahoans.

The Customer Service Specialist is responsible for customer service interactions with providers, subscribers, other carriers, and internal customers regarding benefit clarifications, claim status and resolution, and general product and service questions.

This position operates in a high-volume call center environment, where the primary responsibility is handling inbound calls. Customer Service Specialists can expect to manage approximately 50–100 calls per day, spending 90–95% of their work time actively on the phone.

Essential Functions

• Respond to stakeholder inquiries via phone or written correspondence, accessing reference materials as needed to analyze and determine appropriate response.
• Prepare or process claims and adjustments in an accurate and timely manner.
• Prepare inbound appeals for review.
• Recommend and actively participate in implementing improvements in workflow and processing.
• May perform backup functions in the following areas after additional training: Plan set up; Provider Database Maintenance; processing Orthodontia claims, and others as needed.
• May serve as liaison for JIRA tickets for Dental Services team
• May be assigned to a specialty team depending upon skillset.
• Demonstrate a commitment to the organization’s vision, mission, values, code of ethics, and compliance/security standards.
• Other duties as assigned

Requirements

KNOWLEDGE, SKILLS, AND ABILITIES

• A minimum of 2 years of experience as a Dental Assistant; Dental Hygienist; or front Dental Office staff is required.
• A minimum of 1 year of experience in customer service.
• Knowledge of dental terminology

• Competency in Microsoft Office – Word, Excel, and Outlook
• Excellent oral and written communication skills and the ability to interact with internal and external stakeholders in an effective and positive manner.

• Ability to function with high levels of call volume and workload.
• Ability to understand individual group benefits and master contract provisions.
• Strong skills, abilities, and commitment to teamwork, customer service, and dependability.
• Attention to detail.

PHYSICAL AND MENTAL REQUIREMENTS

• Sitting/Standing (alternatively) continuously
• Keyboard Use/Repetitive Hand motion continuously
• Skill/ability related to comprehension, organization, reasoning/decision-making and communication appropriate to position/level

OUR CULTURE

DDID seeks to provide a positive workplace where employees are treated with respect and all are accountable for living our values and Code of Ethics while empowered to help the organization succeed in achieving its mission and vision.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

Individuals that may need assistance with the applicant or interview process may contact human resources at View email address on us.fitly.work or by phone: View phone number on us.fitly.work.

Benefits

Delta Dental of Idaho offers a competitive benefits plan for eligible staff, including:

• Medical, dental, and vision
• 401K with up to 6% company contribution
• Generous PTO and up to 9 paid holidays
• Community Service time to volunteer in your community
• Hybrid schedule after initial training phase
• Tuition and continuing education reimbursement
• Casual dress code
• ...and more!