Customer Service Representative
Customer Service Representative
Posted on :
13-10-2022
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Job Description
JOB SUMMARY:
The Customer Service Representative position interacts with customers to provide and process information in response to general inquiries, concerns, and requests about products and services across multiple lines of business. The CSR must project a professional company image and provide superior customer service by corresponding with customers via any of customer contact channels.
PRIMARY JOB RESPONSIBILITIES:
- Assist providers by resolving coordination of benefits inquiries by analyzing patient activity (including enrollment, third party liability, and claims attachments).
- Interpret and communicate accurate insurance coverage by having a comprehensive understanding of the process.
- Thoroughly and completely document all customer interactions.
- Educates customers and dental professionals on eligibility, benefits, claims payment, and authorizations.
- Provides direction on the usage and benefits of self-service tools.
- Assist members on gaining access to care by locating a network dentist or assignment to a primary care dentist.
- Appropriately routes inquiries to the necessary departments or individuals when resolution of the inquiry is beyond the span of control of this role.
- Responds to customer inquiries in a courteous and professional manner.
- Researches any assistance requested and consistently provides accurate information to resolve internal and external member and provider inquiries. Communicates response/resolution through all channels including phone, email, web portal, and chat interactions.
- Responds to and resolves internal and external complex customer inquiries via verbal and written communications through all channels including phone, email, web portal, and chat interactions.
- Resolves claim payment inquiries by researching and analyzing patient activity and determines the appropriate actions to be taken.
- Takes ownership of the resolution and sets expectations for follow up.
- Ensures resubmissions, stop payments, and voids are handled appropriately.
- Meets or exceeds individual, department, and client specific goals.
- Understands and adheres to all administrative and contractual policies and procedures.
- Contributes to the success of the organization by suggesting ways to improve the service delivery processes.
- Other duties as assigned.
JOB REQUIREMENTS:
- High School Diploma or Equivalent.
- 2-years of experience in a high-volume customer service environment.
- 1-year experience in health insurance industry.
- Experience utilizing multiple software applications simultaneously.
- Ability to set-up computer equipment and troubleshoot issues with minimal assistance.
- Proven professional verbal and written communication skills.
- Ability to efficiently operate a computer with knowledge of Microsoft Office applications.
- Strong organizational skills and attention to detail.
- Ability to work independently and with a team.
Employment Type
Full Time
Key Skills
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