Bilingual CSR; Mandarin or Cantonese

Overview

Job Summary:

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 Denta Quests 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.
• Educates customers and dental professionals on eligibility, benefits, claims payment, and authorizations.
• Provides 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 routes inquiries to the necessary departments or individuals when resolution of the inquiry is beyond the span of control of this role.
• Responds to customer inquiries in a courteous and professional manner.
• Researches assistance requested and consistently provides 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.
• Responds to and resolves internal and external complex customer inquiries via verbal and written communications through all channels including phone, email, web portal, and chat interactions.
• Resolves claim payment inquiries by researching and analyzing patient activity and determines appropriate action to be taken.
• Ensures resubmissions, stop payments, and voids are handled appropriately.

• High School Diploma or Equivalent.
• 2-years of experience in a high-volume customer service environment.
• 1-year experience in health insurance industry.
• Experience utilizing multiple software applications simultaneously.
• Ability to efficiently operate a computer and knowledge of Microsoft Office applications.

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