Job Description
Important things YOU should know:
- Must be fluent in Spanish
- Fully remote opportunity
- Training schedule: 8:00am- 4:30pm CST Monday – Friday
- Work schedule (after training): 9:30am – 6:00pm CST Monday - Friday
- Hours of operation: 7:00am - 8:00pm CST so shift could flex based on business need
- Occasional evenings, weekends and holidays possible during Annual Medicare Open Enrollment: 10/1 - 3/31
- $2.00/hour differential on Mon/Tues
- Exceptional professional growth in a fun rewarding environment
What will YOU be doing for us?
Our Customer Service Representatives must have strong problem-solving skills, coupled with the natural ability to provide empathy for the customer – always taking the time to patiently listen and understand their questions to help find a viable solution, while providing them with a memorable customer experience.
What is in it for YOU?
- Career growth in an inclusive culture
- Paid training
- Health benefits
- 401(k)
What will YOU be working on every day?
- Servicing our Dental and Vision callers with information regarding their eligibility, benefit coverage, authorizations, claims, and assisting them with locating a provider in their area,
- Utilize knowledge of claim adjustments and resubmission processes to determine appropriate resolution to provider requests.
- Provide feedback to Provider Relations staff on high-level claim issues including but not limited to issues with reimbursement schedules or conflicting information to ensure providers receive a prompt resolution.
- Support enrollment activities including but not limited to assigning primary care providers, and updating third party insurance information.
- Act as liaison between our organization and the client’s Member Services staff to resolve issues such as eligibility and filing appeals and grievances.
- Provide updates to providers with questions regarding the status of their credentialing application.
- Recognize provider questions that could be handled through the use of the provider web portal and provide education to these callers on the benefits of utilizing the technology available.
- Ensure all calls are answered according to company and client guidelines.
- Accurately document call information and resolution in our internal systems.
- Apply effective diffusion techniques when necessary to ensure our customers feel heard, valued and supported.
- Properly identify issues that need to be escalated appropriately to the leadership team.
Additional Responsibilities:
- Provide recommendations on system enhancements and process improvements to management.
- Keep our Provider Relations team updated with provider manual discrepancies, change in locations or any other provider related issues.
- Participate in departmental projects when applicable.
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
- Must be fluent in Spanish
- 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 and the ability to multi-task
- Excellent attention to detail
- Critical thinking skills to quickly analyze and clearly understand a specific request or customer need
- 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
- Previous experience working in a virtual environment
- Understanding of dental, vision and/or medical insurance terminology
- Previous call center experience
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