Dental CS Rep I ()

About the role

Provide customer service to members of multiple benefit plans by analyzing the caller’s needs and providing timely and accurate responses. Answer calls from policyholders, agents, members, providers, and others regarding benefits, eligibility, claims, premiums, or other issues. This is a full-time work-from-home position.

Responsibilities

• Answer a high volume of inbound phone calls regarding dental claims, benefits, premiums, and eligibility involving employer groups, Oregon Health Plan (OHP) and Individual products.
• Provide solutions to problems, confirm eligibility, explain benefits and/or plan coverage.
• Apply mathematical skills to determine correct benefit information and premium amounts for Individual plans.
• Exercise judgement, initiative, and discretion in confidential and sensitive matters.
• Perform related duties:
• Follow HIPAA guidelines to protect member health information.
• Document all aspects of a call in a clear and concise manner.
• Keep up to date on new and revised benefit information, claim processing procedures, or system updates.
• Gather banking details so monthly premium for members on Individual plans can be collected.
• Identify and request claim adjustments when necessary.
• Resolve and record complaints, appeals, and inquiries.
• Contact providers, other insurance companies or state agencies when necessary to answer questions and obtain or provide information.
• Provide timely follow-up and return calls within department guidelines.
• Answer calls within service level time.

Requirements

• High school diploma or equivalent.
• Practical knowledge of medical or dental terminology preferred but not required.
• Knowledge of diagnosis and procedure coding preferred but not required.
• Prior customer service experience, other related experience such as medical/dental office experience, or customer support experience.
• Strong reading, verbal and written communication skills. Ability to interact professionally, patiently, and courteously with customers over the phone.
• Good analytical, problem solving and decision-making skills.
• 10-key proficiency of 105 kspm net on a computer numeric keypad.
• Type a minimum of 35 wpm net on computer keyboard.
• High speed internet (cable or fiber)
• Must be proficient with Microsoft Office applications with the ability to open and navigate multiple windows at the same time.
• Able to achieve and maintain quality standards.
• Able to work well and independently under pressure in a complex and rapidly changing environment.
• Able to meet the attendance and punctuality policy of Moda Health.
• Able to remain focused and on task in a work from home environment.
• Maintain confidentiality and project a professional business presence and appearance.
• Able to repeatedly analyze situations and communicate effectively in a fast-paced environment that includes dealing with escalating queries and concerns.
• Able to organize and remain up to date on changing and new information.
• Able to troubleshoot and follow protocols for reporting internet or technological issues.

Qualifications

• None specified

Skills

• Customer Service
• Medical/Dental Terminology
• Mathematical Skills
• Problem Solving
• Communication Skills
• Computer Proficiency
• Confidentiality
• Time Management
• Technical Troubleshooting

Benefits

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Pay

$18.39- $20.58 hourly (depending on experience)

Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Schedule

Full-time work from home position.