Customer Care Rep II

Important things YOU should know:

• Fully remote opportunity
• Training schedule: 8:00am - 4:30pm CST Monday - Friday
• Work schedule (after training): 10:00am - 6:30pm CST Monday - Friday
• Hours of operation: 7:00am - 10:00pm CST Monday - Friday so shift could flex based on business need
• $2.00/hour differential on Mon/Tues
• Occasional evenings, weekends and holidays possible during Annual Medicare Open Enrollment: 10/1 - 3/31
• Exceptional professional growth in a fun rewarding environment

What will YOU be doing for us?

The Customer Care Representative II (CCRII) is responsible for delivering exceptional service to dental and vision insurance clients, members, and providers on behalf of a variety of government and commercial dental and vision plans. This role involves handling inbound inquiries and outbound communications, resolving benefit and claims issues, and ensuring a seamless experience across all touchpoints with a high degree of accuracy and empathy. The CCRII acts as a knowledgeable liaison between the insurance carriers, providers, and members.

What will YOU be working on every day?

• Service inbound calls from members regarding Dental and Vision by communicating benefits, eligibility, claims and authorization status.
• Provide information and resources necessary to understand benefit plan coverage, verify insurance coverage and assist them with locating providers in their area
• Consistently demonstrate a customer-focused approach, adapting communication style appropriately to meet the needs of diverse customers and situations.
• Service inbound calls from providers, clients, brokers and groups, regarding dental and vision benefits, eligibility information, authorizations, claims, coordination of benefits, and remittance advice
• Apply expertise in claim adjustments and resubmission procedures to accurately assess and resolve provider inquiries.
• Provide feedback to Provider Relations staff on complex issues such as discrepancies in reimbursement schedules or conflicting information to ensure timely and accurate resolution for providers.
• Support enrollment activities including but not limited to assigning primary care providers, adding authorized representatives, and updating secondary insurance information for coordination of benefits.
• Serve as a liaison between our organization and the client's Member Services team to address and resolve issues such as member eligibility, appeals and grievances.
• Provide timely updates to providers regarding the status of their credentialing applications, ensuring clear communication and support throughout the process.
• Identify provider questions that can be addressed through the provider web portal and educate callers on the benefits of utilizing available self-service tools.
• Ensure all inbound calls are answered according to established company, client and state guidelines, maintaining service quality and HIPAA compliance.
• Accurately record call details and resolutions in internal systems to ensure proper documentation and continuity of service.
• Utilize effective de-escalation techniques to ensure our customers feel heard, valued and supported during challenging customer interactions.
• Effectively identify issues requiring escalation to ensure they are appropriately directed to the leadership team for timely resolution.
• Use available resources to effectively and accurately complete calls.

Additional Responsibilities:

• Offer recommendations to management on system enhancements and process improvements to increase efficiency and service quality.
• Keep our Provider Relations and Client Experience teams informed of provider manual discrepancies, location changes, and other provider-related issues to ensure accurate and up-to-date information.
• Participate in departmental projects as needed, contributing to team objectives and organizational initiatives.

What qualifications do YOU need to have to be GOOD candidate?

Required Level of Education, Licenses, and/or Certificates

• High school diploma or equivalent.

Required Level of Experience

• 1+ years of job related customer service experience within industries such as healthcare, call center, banking or retail.

Required Knowledge, Skills, and Abilities

• Basic knowledge of Microsoft Office products including but not limited to Word, Excel, and Outlook.
• Ability to work occasional overtime as needed.
• Excellent listening and communication skills.
• Superior customer service skills including the natural ability to provide empathy.
• Strong data entry/typing skills.
• Strong navigation skills of multiple systems and ability to multi-task.
• Excellent attention to detail.
• Critical thinking skills to quickly analyze and clearly understand a specific request or customer need and then leverage knowledge and resources to provide the appropriate solutions.

What qualifications do YOU need to be a GREAT candidate?

Preferred Level of Experience

• 1+ years of job related customer service experience within the dental, vision or medical industry.
• Proven ability to thrive in a virtual environment.

Preferred Knowledge, Skills, and Abilities

• Understanding of dental, vision and/or medical insurance terminology.