Customer Care Rep II - Fully Remote!

SKYGEN•United States,

10d•$16 - $25•Remote

About The Position

The Customer Care Rep II provides customer service to dental and vision providers and callers, using problem-solving skills and empathy to listen, understand questions, and identify appropriate solutions. The role handles inquiries about eligibility, benefit coverage, authorizations, claims, provider searches, credentialing applications, enrollment, and appeals or grievances. Representatives document interactions, follow company and client guidelines, educate callers about the provider web portal, and escalate issues when needed. This is a fully remote position. Training is scheduled Monday through Friday, 8:00 a.m. to 4:30 p.m. CST for the first 12 weeks. After training, schedules may start between 6:00 a.m. and 10:30 a.m. CST, Monday through Friday. Hours of operation are 6:00 a.m. to 10:00 p.m. CST on weekdays, and shifts may vary based on business needs. Occasional evenings, weekends, and holidays may be possible during Annual Medicare Open Enrollment, October 1 through March 31. A $2.00-per-hour differential applies on Mondays and Tuesdays. Occasional overtime may be needed. The position offers professional growth in a fun, rewarding environment.

Requirements

High school diploma or equivalent.
At least 1 year of job-related customer service experience in an industry such as healthcare, call center, banking, or retail.
Basic knowledge of Microsoft Office products, including Word, Excel, and Outlook.
Ability to work occasional overtime as needed.
Excellent listening and communication skills.
Strong customer service skills and the ability to show empathy.
Strong data-entry and typing skills.
Strong navigation skills and the ability to multitask.
Excellent attention to detail.
Critical-thinking skills to analyze customer requests or needs and use available knowledge and resources to provide appropriate solutions.

Nice To Haves

At least 1 year of job-related customer service experience in the dental, vision, or medical industry.
Previous experience working in a virtual environment.
Understanding of dental, vision, and/or medical insurance terminology.

Responsibilities

Service inbound dental and vision calls about eligibility, benefit coverage, authorizations, claims, and finding providers.
Use knowledge of claim adjustments and resubmission processes to determine resolutions to provider requests.
Provide Provider Relations staff with feedback on high-level claim issues, including reimbursement schedule issues and conflicting information, to support prompt resolution.
Support enrollment activities, including assigning primary care providers and updating third-party insurance information.
Liaise between the organization and client Member Services staff to resolve eligibility issues and assist with filing appeals and grievances.
Provide providers with updates about the status of credentialing applications.
Identify questions that could be addressed through the provider web portal and educate callers about its benefits.
Answer calls according to company and client guidelines.
Accurately document call information and resolutions in internal systems.
Use effective de-escalation techniques so customers feel heard, valued, and supported.
Identify issues requiring escalation to the leadership team.
Recommend system enhancements and process improvements to management.
Keep the Provider Relations team informed about provider manual discrepancies, location changes, and other provider-related issues.
Participate in departmental projects when applicable.