Government Programs Customer Service Representative

About the Role

Candidates must reside in Michigan within a reasonable commuting distance of our Farmington Hills office for team meetings, collaborative sessions, and training. At Delta Dental of Michigan, Ohio, and Indiana, we work to improve oral health through benefit plans, advocacy, and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation. At Delta Dental, we celebrate our All In culture—a mindset, feeling, and attitude we wrap around all that we do, from taking charge of our careers to helping colleagues and lending a hand in the community.

Responsibilities

• Promptly and professionally respond to member, client, and provider questions through multiple channels, including telephone, email, fax, and U.S. mail, using proper etiquette, grammar, and punctuation.
• Clearly and accurately communicate all eligibility, benefit, claim status, and payment information related to caller’s questions.
• Properly identify the reason(s) for the call and provide appropriate resolution to inquiries and complaints within specified timeframes and guidelines established by regulatory agencies or client contracts.
• Inform and assist callers with grievance and claims appeals processes, as necessary.
• Clearly, accurately, and thoroughly document information in the customer relationship management system to ensure all relevant details of the phone call are captured.
• Understand the importance of adhering to regulatory requirements.
• Meet or exceed quality standards as required for the position.
• Meet or exceed call center metrics as required for the position.
• Enter and adjust claims as required.

Requirements

• Ability to work an assigned eight (8) hour schedule starting as early as 7:55 a.m. and ending as late as 11:00 p.m., Monday through Friday.
• Possess a high school diploma or equivalent; an associate’s degree in business administration or a related field is preferred.
• Two years of customer service experience in a business environment that requires the use of a software application to assist customers, preferably in a call center assisting Medicare and/or Medicaid enrollees.
• Demonstrated knowledge of personal computers and software applications (including Windows) through previous experience and/or coursework.

Assessments

• Successful completion of the customer service simulation assessment with a minimum score of 62 out of 100 (assessment waived if candidate previously passed the test while at Delta Dental or if previously held a Customer Service Trainee, Customer Service Advisor, or Customer Service Associate position).
• Successful completion of the customer service multitasking and call logging assessment with a minimum score of 65 out of 100.
• Successful completion of the customer service email composition assessment with a minimum score of 62 out of 100.