Healthcare Member Services Specialist

You will contribute to the strength of our team approach to collaborative dental health.

Do you value making an impact and doing meaningful work? Are you ready to be a difference-maker at an established independent Employee-Owned specialized healthcare company? If you enjoy working with a team of caring and dedicated people, this could be your new home!

Job Summary

The Member Service Specialist addresses member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for dental care. Responsible for receiving, responding to, and directing member phone calls, or written questions. Provides available information upon request and researches or escalates issues as appropriate. Maintains confidentiality per HIPAA guidelines.

Essential Responsibilities

• Provides information and guidance in response to telephone inquiries from members, dentists, brokers and group contacts in a professional and supportive manner.
• Acts as a mediator for member, groups, providers and others to resolve problems and concerns, and answer questions based upon Dental Health Services company plans, policies and procedures.
• Maintains daily and pending phone logs for maintaining accurate department records and follow ups.
• Assists dental offices and members in verifying and communicating member eligibility. Makes arrangements for member second opinions and authorizes emergency referrals.
• Answer questions member may have regarding treatment and charges.
• Provides plan benefit information to existing members. Assists in keeping all member information updated in data systems.
• Researches files, checks billing and interface with other departments to collect data necessary to respond to inquiries.
• Assist UTU Trust Fund with member eligibility and communicating eligibility to dental offices.
• Actively seeks to identify member problems and work to resolve them in a timely manner and confirms caller satisfaction in all interactions.
• Performs any and all additional duties as requested and directed for this position.

Basic Qualifications

Experience

• Minimum of 1-2 years of related experience

Education

• High school diploma or equivalent
• Some college preferred

License, Certification, Registration

• N/A

Additional Requirements

• Excellent interpersonal, oral and written communication skills
• Computer literacy is required
• Well organized
• Detail-oriented

Preferred Qualifications

• Knowledge of dental terminology and procedures
• Bilingual English/Spanish
• Previous experience in a customer service call center

Position Details

• Primary Location: Long Beach, California
• Job Schedule: Full time
• Scheduled Weekly Hours: 40
• Shift: Monday - Friday between the hours of 8:00 am to 6:00 pm, Overtime as needed
• Travel: No

We look forward to having you on our team!