Customer Experience Representative
OVERVIEW OF POSITION: The Customer Experience Representative handles providing service to the client base through effective verbal and written communication as well as troubleshooting and resolving all types of dental claim-related inquiries.
DUTIES & RESPONSIBILITIES:
· Understanding of dental terminology.
· Ability to use good judgment when applying dental knowledge when processing claims and handling client calls.
· Accurately respond to verbal and written inquiries and complaints directly from subscribers, providers, brokers, or group administrators.
· Accurately process claim adjustments during the phone call and/or during regular work time.
· Review and process claims according to established business rules that have failed computer program edits.
· Maintain and follow up on documents for all adjustment requests, check investigations, overpayment letters, and e-forms.
· Complete and keep daily logs/forms/reports.
· Aid in new representatives’ training.
· Accurately completes special projects assigned within specified times.
· Continued training in calls and claims with further progression based on meeting performance requirements.
· Accesses EPHI following the current guidelines as set up at the company-wide and department levels.
· Maintains regular attendance and punctuality.
· Performs other job-related duties as assigned.
· Ability to provide feedback to CS leadership or team members to contribute to one common goal.
EXPERIENCE & QUALIFICATIONS:
· Strong customer service skills.
· Excellent oral and written communication skills.
· Strong computer keyboard skills and capable of working in an ACD environment with talk and work time goals.
· Knowledge of insurance reimbursement practices, i.e., processing policies, deductibles, maximums, Coordination of Benefits (COB), and dental terminology.
· Ability to work independently and execute multiple tasks simultaneously.
· Excellent attendance and punctuality record.
· Strong organizational skills and diligence.
· High School Diploma or Equivalent.
· Speak Spanish fluently.
· Ability to review dental photos and x-rays and make diagnostic determinations based on provider claim narratives.
Job Type: Full-time
Pay: $19.00 - $20.00 per hour
Shift:
- Morning shift
Weekly day range:
- Monday to Friday
Work setting:
- In-person
Education:
- High school or equivalent (Required)
Experience:
- Customer: 2 years (Required)
- dental claims: 2 years (Required)
- customer service: 2 years (Required)
- ACD environment: 2 years (Required)
- insurance reimbursement practices: 2 years (Required)
- processing policies: 2 years (Required)
- deductibles: 2 years (Required)
- maximums: 2 years (Required)
- Coordination of Benefits (COB): 2 years (Required)
- dental terminology: 2 years (Required)
- review dental photos and x-rays: 2 years (Required)
Language:
- Spanish (Required)
Ability to Commute:
- Naperville, IL 60563 (Required)
Work Location: In person