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Customer Care Representative I

Customer Care Representative I

SKYGENMenomonee Falls, WI, United States
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Important things YOU should know :

  • Fully remote opportunity
  • Training schedule (Initial 90 days) : 8 : 00am - 4 : 30pm CST - Monday - Friday
  • Work schedule (after training) : 9 : 00am - 5 : 30pm CST - Monday - Friday
  • 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 is in it for YOU?

  • Career growth in an inclusive culture
  • Paid training
  • Health benefits
  • 401(k)

    • 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, call center, banking or retail.

  • Required Knowledge, Skills, and Abilities

    • Basic knowledge of Microsoft Office products including but not limited to Word, Excel, and Outlook.

  • Ability to work occasional overtime as needed.
  • Excellent listening and communication skills.
  • Superior customer service skills including the natural ability to provide empathy.
  • Strong data entry / typing skills.
  • Strong navigation skills and the ability to multi-task.
  • Excellent attention to detail.
  • Critical thinking skills to quickly analyze and clearly understand a specific request or customer need and then leverage knowledge and resources to provide the appropriate solutions.

    • What qualifications do YOU need to be a GREAT candidate?

  • Preferred Level of Experience

    • 1+ years of job related customer service experience within the dental, vision or medical industry.

  • Previous experience working in a virtual environment.
  • Understanding of dental, vision and / or medical insurance terminology.
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