What are the responsibilities and job description for the Medical Benefits Customer Service Representative position at Action Personnel Inc?
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