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Role Description

The Customer Care Representative II (CCRII) is responsible for delivering exceptional service to dental and vision insurance clients, members, and providers on behalf of a variety of government and commercial dental and vision plans. This role involves:

• Handling inbound inquiries and outbound communications
• Resolving benefit and claims issues
• Ensuring a seamless experience across all touchpoints with a high degree of accuracy and empathy
• Acting as a knowledgeable liaison between the insurance carriers, providers, and members

Daily responsibilities include:

• Service inbound calls from members regarding Dental and Vision by communicating benefits, eligibility, claims, and authorization status
• Provide information and resources necessary to understand benefit plan coverage, verify insurance coverage, and assist them with locating providers in their area
• Consistently demonstrate a customer-focused approach, adapting communication style appropriately to meet the needs of diverse customers and situations
• Service inbound calls from providers, clients, brokers, and groups regarding dental and vision benefits, eligibility information, authorizations, claims, coordination of benefits, and remittance advice
• Apply expertise in claim adjustments and resubmission procedures to accurately assess and resolve provider inquiries
• Provide feedback to Provider Relations staff on complex issues such as discrepancies in reimbursement schedules or conflicting information to ensure timely and accurate resolution for providers
• Support enrollment activities including but not limited to assigning primary care providers, adding authorized representatives, and updating secondary insurance information for coordination of benefits
• Serve as a liaison between our organization and the client’s Member Services team to address and resolve issues such as member eligibility, appeals, and grievances
• Provide timely updates to providers regarding the status of their credentialing applications, ensuring clear communication and support throughout the process
• Identify provider questions that can be addressed through the provider web portal and educate callers on the benefits of utilizing available self-service tools
• Ensure all inbound calls are answered according to established company, client, and state guidelines, maintaining service quality and HIPAA compliance
• Accurately record call details and resolutions in internal systems to ensure proper documentation and continuity of service
• Utilize effective de-escalation techniques to ensure our customers feel heard, valued, and supported during challenging customer interactions
• Effectively identify issues requiring escalation to ensure they are appropriately directed to the leadership team for timely resolution
• Use available resources to effectively and accurately complete calls

Additional Responsibilities:

• Offer recommendations to management on system enhancements and process improvements to increase efficiency and service quality
• Keep our Provider Relations and Client Experience teams informed of provider manual discrepancies, location changes, and other provider-related issues to ensure accurate and up-to-date information
• Participate in departmental projects as needed, contributing to team objectives and organizational initiatives

Qualifications

• High school diploma or equivalent
• 1+ years of job-related customer service experience within industries such as healthcare, call center, banking, or retail
• 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 of multiple systems and ability to multi-task
• Excellent attention to detail
• Critical thinking skills to quickly analyze and clearly understand a specific request or customer need and then leverage knowledge and resources to provide the appropriate solutions

Requirements

• 1+ years of job-related customer service experience within the dental, vision, or medical industry (preferred)
• Proven ability to thrive in a virtual environment (preferred)
• Understanding of dental, vision, and/or medical insurance terminology (preferred)

Benefits

• Fully remote opportunity
• Training schedule: 8:00am - 4:30pm CST Monday – Friday
• Work schedule (after training): 10:00am – 6:30pm CST Monday - Friday
• Hours of operation: 7:00am - 10:00pm CST Monday - Friday so shift could flex based on business need
• $2.00/hour differential on Mon/Tues
• Occasional evenings, weekends, and holidays possible during Annual Medicare Open Enrollment: 10/1 - 3/31
• Exceptional professional growth in a fun rewarding environment