Customer Care Representative II - Remote Role in Healthcare Insurance

About the Company

The employer operates within the healthcare insurance industry, specializing in dental and vision coverage. Their services focus on helping customers navigate eligibility, coverage, claims processing, and offer dedicated support to both members and healthcare providers.

Position Overview

The role of Customer Care Representative II involves delivering compassionate and effective assistance to individuals requiring help with dental and vision insurance benefits. This position is crucial in addressing members' and providers' inquiries, assisting with enrollment, and facilitating communication between providers and Member Services to uphold service quality and operational efficiency.

Key Responsibilities

• Field inbound calls concerning eligibility, benefits, authorizations, claims, and assistance locating providers for dental and vision plans.
• Address provider requests related to claims adjustment and resubmission.
• Escalate complex claims issues to Provider Relations for prompt resolution.
• Support enrollment functions by assigning primary care providers and updating insurance details.
• Coordinate with Member Services to handle eligibility concerns, appeals, and grievances.
• Inform providers about the progress of credentialing applications.
• Train providers on utilizing the web portal for common questions.
• Ensure calls comply with company and client quality standards.
• Document call information and resolutions accurately within internal systems.
• Apply empathetic communication techniques to ensure customers feel respected and supported.
• Identify issues requiring escalation to leadership.
• Suggest improvements to systems and processes.
• Keep Provider Relations updated on any discrepancies or changes impacting providers.
• Contribute to departmental projects as necessary.

Required Qualifications

• High school diploma or equivalent certification.
• At least one year of customer service experience; preference given to healthcare, call center, banking, or retail backgrounds.
• Basic proficiency in Microsoft Office suite including Word, Excel, and Outlook.
• Willingness to work overtime occasionally.
• Strong communication, active listening, and empathy skills.
• Efficient data entry and typing capabilities.
• Exceptional multitasking and navigation skills.
• Detail-oriented with critical thinking ability to assess requests and determine suitable solutions.
• Preferred candidates have over one year of experience in dental, vision, or medical insurance customer service.
• Virtual work experience preferred.
• Familiarity with dental, vision, or medical insurance terminology is an added advantage.

Compensation & Benefits

• Compensation package varies based on experience and skills.
• An additional $2.00 per hour differential applies on Mondays and Tuesdays.
• This is a fully remote position.
• Initial training schedule is from 8:00 AM to 4:30 PM CST for 12 weeks.
• Post-training work hours are 10:30 AM to 7:00 PM CST, Monday through Friday.
• Availability for occasional evenings, weekends, and holidays may be required between October 1 and March 31 during the Annual Medicare Open Enrollment period.
• Opportunities for career development within a rewarding work environment.

Equal Opportunity Employment

The employer is committed to maintaining a diverse and inclusive workplace. They provide equal employment opportunities to all candidates irrespective of race, color, religion, gender, sexual orientation, gender identity or expression, or national origin.