You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.
DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.
Job Description:
Customer Service Representative II
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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.Qualifications
- 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 skills
- Associate’s degree preferred
- Previous claims payment experience preferred.
- Dental terminology knowledge and group health insurance experience a plus.
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.
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 email recruitingUS@sunlife.com to request an accommodation.
At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.
For applicants residing in California, please read our employee California Privacy Policy and Notice.
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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran
