Customer Service Representative - Back Office

Location: Connecticut, United States

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Remote Opportunity: 1

Requisition Number: 3710

Position Title: Customer Service Representative II

External Description:

JOB SUMMARY: This position interacts with customers to provide and process information in response to complex inquiries, concerns, and requests about product and services across multiple lines of business. Projects a professional company image and provides superior customer service by corresponding with customers via any of DentaQuest’s customer contact channels.

PRIMARY JOB RESPONSIBILITIES:

  • Responds to and resolves internal and external complex customer inquiries via verbal and written communications through all channels including phone, email, web portal, and chat interactions.
  • Thoroughly and completely document all customer interactions.
  • Educates customers and dental professionals on eligibility, benefits, claims payment, and authorizations.
  • Provides direction on the usage and benefits of self-service tools.
  • Resolve claim payment inquiries by researching and analyzing patient activity and determine appropriate action to be taken.
  • Adjusts claims data, when appropriate, to immediately resolve the inquiry and maintain first call resolution expectations.
  • Ensure resubmissions, stop payments, and voids are handled appropriately.
  • Appropriately route inquiries to the necessary departments or individuals when resolution of the inquiry is beyond the span of control of this role.
  • Meet or exceed individual, department, and client specific goals. Assist providers by resolving coordination of benefits inquiries by analyzing patient activity (including enrollment, third party liability, and claims attachments).
  • Interpret and communicate accurate insurance coverage by having a comprehensive understanding of the process.
  • Meet or exceed individual and department goals.
  • Run required reports, as needed.
  • Understands and adheres to all of DentaQuest’s administrative and contractual policies and procedures.
  • Takes ownership of the resolution and sets expectations for follow up.
  • Other duties as assigned.

JOB REQUIREMENTS:

  • High School Diploma or equivalent required.
  • 3 years of experience in a high volume customer service environment.
  • Proven professional verbal and written communication skills.
  • Ability to efficiently operate a computer and knowledge of Microsoft Office applications.
  • Strong organizational skills and attention to detail skills.
  • Ability to work independently and with a team.
  • Ability to learn quickly and adapt to a fast pace production environment.
  • Cooperative, professional and effective interaction skills with co-workers, company staff and visitors.
  • Critical thinking and problem solving skills.
  • Required to attend additional training as requested/deemed necessary.

Preferred:

  • Associate’s degree preferred Previous claims payment experience preferred.
  • Dental terminology knowledge and group health insurance experience a plus.

PHYSICAL DEMANDS: Incumbent must be able to communicate effectively. Requires overall light physical effort (up to 25lbs.) Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal computer). Ability to travel or move about within and outside serviced facilities required. Incumbent works primarily in either a private or shared office environment.

City: Remote

State: Connecticut

Community / Marketing Title: Customer Service Representative - Back Office

Company Profile:

We believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.

Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it. 

To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.

The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.

Company Profile Job:

At DentaQuest, we believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.

Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it. 

To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.

The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.

Location_formattedLocationLong: Remote, Connecticut US

CountryEEOText_Description: In accordance with our Compliance Plan, employees must conduct business in accordance with applicable laws, regulations, professional standards and ethical standards and report potential compliance or ethical issues to manager or Compliance Officer. Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please see Human Resources for additional information regarding this Program. Equal Employment Opportunity Statement: We are committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, or sexual orientation.

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