OVERVIEW OF POSITION: The Customer Experience Representative handles providing service to the client base through effective verbal and written communication as well as troubleshooting and resolving all types of dental claim-related inquiries.

DUTIES & RESPONSIBILITIES:

· Understanding of dental terminology.

· Ability to use good judgment when applying dental knowledge when processing claims and handling client calls.

· Accurately respond to verbal and written inquiries and complaints directly from subscribers, providers, brokers, or group administrators.

· Accurately process claim adjustments during the phone call and/or during regular work time.

· Review and process claims according to established business rules that have failed computer program edits.

· Maintain and follow up on documents for all adjustment requests, check investigations, overpayment letters, and e-forms.

· Complete and keep daily logs/forms/reports.

· Aid in new representatives’ training.

· Accurately completes special projects assigned within specified times.

· Continued training in calls and claims with further progression based on meeting performance requirements.

· Accesses EPHI following the current guidelines as set up at the company-wide and department levels.

· Maintains regular attendance and punctuality.

· Performs other job-related duties as assigned.

· Ability to provide feedback to CS leadership or team members to contribute to one common goal.

EXPERIENCE & QUALIFICATIONS:

· Strong customer service skills.

· Excellent oral and written communication skills.

· Strong computer keyboard skills and capable of working in an ACD environment with talk and work time goals.

· Knowledge of insurance reimbursement practices, i.e., processing policies, deductibles, maximums, Coordination of Benefits (COB), and dental terminology.

· Ability to work independently and execute multiple tasks simultaneously.

· Excellent attendance and punctuality record.

· Strong organizational skills and diligence.

· High School Diploma or Equivalent.

· Speak Spanish fluently.

· Ability to review dental photos and x-rays and make diagnostic determinations based on provider claim narratives.