Customer Service Specialist

Customer Service Specialist

Culture rules at Delta Dental. It's key to our becoming the leading dental benefits carrier in the state, reaching over 500,000 Idahoans with our dental plans and community outreach programs. We're small on ego and big on grins. You'll see us involved in community events and "Did you make someone smile today?" on our To-Do lists. Our employees have the opportunity to make a difference in people's lives while working in an environment full of challenge, collaboration, flexibility, and industry-leading growth potential.

Join our team committed to better oral health for all Idahoans.

The Customer Service Specialist is responsible for customer service interactions with providers, subscribers, other carriers, and internal customers regarding benefit clarifications, claim status and resolution, and general product and service questions.

This position operates in a high-volume call center environment, where the primary responsibility is handling inbound calls. Customer Service Specialists can expect to manage approximately 50–100 calls per day, spending 90–95% of their work time actively on the phone.

Essential Functions

• Respond to stakeholder inquiries via phone or written correspondence, accessing reference materials as needed to analyze and determine appropriate response.
• Prepare or process claims and adjustments in an accurate and timely manner.
• Prepare inbound appeals for review.
• Recommend and actively participate in implementing improvements in workflow and processing.
• May perform backup functions in the following areas after additional training:
  Plan set up;
  Provider Database Maintenance; processing Orthodontia claims, and others as needed.
• May serve as liaison for JIRA tickets for Dental Services team
• May be assigned to a specialty team depending upon skillset.
• Demonstrate a commitment to the organization's vision, mission, values, code of ethics, and compliance/security standards.
• Other duties as assigned