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Benefit Services Representative
2 months ago
Position Summary:
Receives telephone inquiries and provides information to subscribers, providers, and group administrators regarding their dental benefits. Resolves claim problems, writes up corrections, and watches for claim adjudication adjustments. Returns calls to the providers and subscribers. Enters comments after every call and routes calls to appropriate department for resolution.
Essential Functions:
- Answers telephone calls from subscribers, dental providers and group administrators in a courteous and professional manner.
- Provides information to group administrators on eligibility and benefit coverage.
- Issues ID cards.
- Submits claims to Professional Review when the dental office is requesting an appeal.
- Provides names of participating dentists and their office locations to subscribers.
- Explains benefits and frequencies for dental services.
- Explains how a claim was processed and paid.
- Researches claim problems and makes necessary corrections.
- Responds to correspondence.
- Returns calls to providers and subscribers.
- Enters comments after each phone call.
- Routes calls to appropriate department for resolution.
- Explains how appeals can be submitted.
- Makes address changes.
- Other duties as assigned to meet business needs.
Qualifications/Education/Experience:
- High school diploma or GED equivalent.
- A minimum of one year prior customer service experience.
- Demonstrated PC experience, the ability to use a copier and fax machine.
- Excellent verbal and written communication skills.
- The ability to communicate in a professional manner.
- Preferred qualifications include prior medical or dental insurance experience and/or experience working in a customer services center.
- Strong interpersonal and communication skills
Physical Demands and Work Environment:
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Physical demands: While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk or hear. Use of hands is required for such technological devices such as a computer, telephone, and others. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. The employee will be required to travel (sometimes long distances) to attend required meetings.
- Work environment: The work is limited to the office environment with occasional trips to other office facilities or locations necessitating walking outdoors or driving. The noise level in the work environment is usually minimal.
