Medical Benefits Customer Service Representative

We are seeking a professional and customer-focused Medical Benefits Customer Service Representative to handle incoming inquiries related to benefits, claims, and provider support. The ideal candidate is patient, detail-oriented, and able to communicate clearly with subscribers, dental providers, and group administrators.

Responsibilities

• Answer telephone calls from subscribers, providers, and group administrators in a courteous and professional manner

• Provide information regarding eligibility, dental benefits, coverage levels, and frequencies

• Explain how claims are processed and paid

• Resolve claim issues, complete corrections, and monitor adjudication adjustments

• Submit claims to Professional Review when an appeal is requested

• Issue ID cards as needed

• Provide participating dentist names and office locations

• Respond to written correspondence

• Make address changes and update member information

• Return calls to subscribers and providers in a timely manner

• Enter detailed comments after each call

• Route calls to the appropriate department when necessary

• Explain the appeals process and assist with next steps

• Perform additional duties as assigned to support business needs

Qualifications

• High school diploma or GED required

• Minimum of one year of prior customer service experience

• Proficient with PCs, office equipment (copier, fax), and data entry

• Excellent verbal and written communication skills

• Ability to communicate professionally with diverse customers

• Strong interpersonal skills and problem-solving abilities

• Preferred: experience with medical or dental insurance and/or call center environments