Customer Care Rep II - Virtual!

**Important things YOU should know:** * Fully remote opportunity * Training schedule 8:00am \- 4:30pm Monday – Friday CST * Work schedule (after training): 10:00am \- 6:30pm CST Mon \- Fri * Hours of operation: 7:00am \- 10:00pm CST Monday \- Friday so shift could flex based on business need * $2\.00/hour differential on Mon/Tues * Occasional evenings, weekends and holidays possible during Annual Medicare Open Enrollment: 10/1 \- 3/31 Exceptional professional growth in a fun rewarding environment * **What will YOU be doing for us?** Our Customer Service Representatives must have strong problem\-solving skills, coupled with the natural ability to provide empathy for the customer – always taking the time to patiently listen and understand their questions to help find a viable solution, while providing them with a memorable customer experience. **What will YOU be working on every day?** * Servicing our Dental and Vision inbound callers with information regarding their eligibility, benefit coverage, authorizations, claims, and assisting them with locating a provider in their area, * Utilize knowledge of claim adjustments and resubmission processes to determine appropriate resolution to provider requests. * Provide feedback to Provider Relations staff on high\-level claim issues including but not limited to issues with reimbursement schedules or conflicting information to ensure providers receive a prompt resolution. * Support enrollment activities including but not limited to assigning primary care providers, and updating third party insurance information. * Act as liaison between our organization and the client’s Member Services staff to resolve issues such as eligibility and filing appeals and grievances. * Provide updates to providers with questions regarding the status of their credentialing application. * Recognize provider questions that could be handled through the use of the provider web portal and provide education to these callers on the benefits of utilizing the technology available. * Ensure all calls are answered according to company and client guidelines. * Accurately document call information and resolution in our internal systems. * Apply effective diffusion techniques when necessary to ensure our customers feel heard, valued and supported. * Properly identify issues that need to be escalated appropriately to the leadership team. Additional Responsibilities: * Provide recommendations on system enhancements and process improvements to management. * Keep our Provider Relations team updated with provider manual discrepancies, change in locations or any other provider related issues. Participate in departmental projects when applicable. * **What qualifications do YOU need to have to be GOOD candidate?** Required Level of Education, Licenses, and/or Certificates * High school diploma or equivalent. * Required Level of Experience 1\+ years of job related customer service experience within industries such as healthcare, ca