Customer Service Representative

Location: Irvine, CA

Onsite Flexibility: Remote

• Position Type: Contract
• Contract Duration: 3 months
• Shift / Schedule: Contact center operates from 8:00 AM to 6:00 PM PST, with shifts typically scheduled as 8:00 AM to 5:00 PM or 9:00 AM to 6:00 PM. During Open Enrollment Season (November 1 through January 31), a rotating schedule applies:
  Monday to Friday 8:00 AM to 8:00 PM PST;
  Saturday 8:00 AM to 6:00 PM PST.
• Work Authorization: Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.

The Customer Service Representative position interacts with customers to provide and process information in response to general inquiries, concerns, and requests about products and services across multiple lines of business. The CSR must project a professional company image and provide superior customer service by corresponding with customers via any of the client's customer contact channels.

• Assist providers by resolving coordination of benefits inquiries by analyzing patient activity (including enrollment, third party liability, and claims attachments).
• Interpret and communicate accurate insurance coverage by having a comprehensive understanding of the process.
• Thoroughly and completely document all customer interactions.
• Educate customers and dental professionals on eligibility, benefits, claims payment, and authorizations.
• Provide direction on the usage and benefits of self-service tools.
• Assist members on gaining access to care by locating a network dentist or assignment to a primary care dentist.
• Appropriately route inquiries to the necessary departments or individuals when resolution of the inquiry is beyond the span of control of this role.
• Respond to customer inquiries in a courteous and professional manner.
• Research inquiries and consistently provide accurate information to resolve internal and external member and provider inquiries via verbal and written communications through all channels including phone, email, web portal, and chat interactions.
• Respond to and resolve internal and external complex customer inquiries via verbal and written communications through all channels including phone, email, web portal, and chat interactions.
• Resolve claim payment inquiries by researching and analyzing patient activity and determine appropriate action to be taken.
• Take ownership of the resolution and set expectations for follow up.
• Ensure resubmissions, stop payments, and voids are handled appropriately.
• Meet or exceed individual, department, and client specific goals.
• Understand and adhere to all administrative and contractual policies and procedures.
• Contribute to the success of the organization by suggesting ways to improve the service delivery processes.
• Other duties as assigned.

• Experience utilizing multiple software applications simultaneously.
• Ability to set up computer equipment and troubleshoot issues with minimal assistance.
• Proven professional verbal and written communication skills.
• Ability to efficiently operate a computer and knowledge of Microsoft Office applications.
• Strong organizational skills and attention to detail.
• Ability to work independently and with a team.
• Ability to learn quickly and adapt to a fast-paced production environment.
• Cooperative, professional, and effective interaction skills with co-workers, company staff, and visitors.
• Critical thinking and problem-solving skills.
• Ability to tolerate repetitive work without compromising accuracy and service levels.
• Required to attend additional training as requested/deemed necessary.
• Bilingual fluency in English and Spanish required.

• Medical/Dental terminology knowledge experience.
• Medicare/Medicaid knowledge.
• Claims/Billing and coding experience.
• Experience with Cisco phone system a plus.

• High School Diploma or Equivalent required.

• 2 years of experience in a high-volume customer service environment.
• 1 year of experience in the health insurance industry.

• Incumbent must be able to communicate effectively.
• Manual dexterity and sitting is required in carrying out position responsibilities (i.e., use of personal computer).
• Incumbent works primarily in either a private or shared office environment.

• Ability to work during the Open Enrollment season (November 1 through January 31) is mandatory. Candidates who cannot support these requirements will not be considered.
• Candidates will begin in training cohorts. There will be approximately two weeks between cohort start dates and training sessions.
• Remote within the U.S.; candidates must be available to work PST business hours.

This client is a leading global financial organization operating across insurance, investments, and asset management, with a presence spanning international markets. The organization employs professionals across customer…