Job Details

Description

We are seeking a professional and customer-focused Medical Benefits Customer Service Representative to handle incoming inquiries related to benefits, claims, and provider support. The ideal candidate is patient, detail-oriented, and able to communicate clearly with subscribers, dental providers, and group administrators.
Responsibilities

• Answer telephone calls from subscribers, providers, and group administrators in a courteous and professional manner
• Provide information regarding eligibility, dental benefits, coverage levels, and frequencies
• Explain how claims are processed and paid
• Resolve claim issues, complete corrections, and monitor adjudication adjustments
• Submit claims to Professional Review when an appeal is requested
• Issue ID cards as needed
• Provide participating dentist names and office locations
• Respond to written correspondence
• Make address changes and update member information
• Return calls to subscribers and providers in a timely manner
• Enter detailed comments after each call
• Route calls to the appropriate department when necessary
• Explain the appeals process and assist with next steps
• Perform additional duties as assigned to support business needs

• High school diploma or GED required
• Minimum of one year of prior customer service experience
• Proficient with PCs, office equipment (copier, fax), and data entry
• Excellent verbal and written communication skills
• Ability to communicate professionally with diverse customers
• Strong interpersonal skills and problem-solving abilities
• Preferred: experience with medical or dental insurance and/or call center environments