Customer Service Representative

Delta Dental of New Mexico•Albuquerque, NM

3d•Onsite

About The Position

To provide polite, accurate and professional customer service related to eligibility, dental benefits, and claim payment; performs claim and benefit research, reconciliation, adjudication, data entry, adjustments, and related reporting. Respond to written inquiries in a timely and professional manner. PRIMARY JOB RESPONSIBILITIES: Role model and live the company values and behaviors. Know the company vision, mission, and objectives and continually communicate and reinforce these to fellow Team Members. Responds to member inquiries via telephone, e-mail, or chat. Open, sort, and scan incoming claim and non-claim related mail. Completes timely and accurate entry of claims related data including the auditing, coding, and entry of claims. Maintains the required performance standards relating specifically to Customer Services and claims accuracy. Maintains files and databases as required by department policies and procedures. Coordinates inquiries requiring additional information with other departments in a cooperative, efficient, and professional manner. Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above. Foster, encourage, and reward a fun, positive, successful, values-based culture! __________________________________________________________________________ PERFORMANCE REQUIREMENTS: The following are required of the CSR position: Completes timely and accurate entry of claims related data including the auditing, coding, and entry of claims at or above 95%. Quality Scoring for telephone calls at 3.0 or above.

Requirements

High School Diploma
Good computer skills and working knowledge of Microsoft applications sufficient to independently perform claim related functions and produce customer communications
The ability to provide consistent, efficient, accurate, and quality customer service
Excellent time management skills and ability to manage multiple tasks with multiple time deadlines also required
Effective oral and written communication skills
Ability to lift 30 pounds
Completes timely and accurate entry of claims related data including the auditing, coding, and entry of claims at or above 95%
Quality Scoring for telephone calls at 3.0 or above

Nice To Haves

Bilingual a plus
One (1) year experience in public relations or customer service, preferably in the group benefits/insurance field.
Will accept any suitable combination of education, training, or experience.

Responsibilities

Provide polite, accurate and professional customer service related to eligibility, dental benefits, and claim payment
Perform claim and benefit research, reconciliation, adjudication, data entry, adjustments, and related reporting
Respond to written inquiries in a timely and professional manner
Role model and live the company values and behaviors
Know the company vision, mission, and objectives and continually communicate and reinforce these to fellow Team Members
Respond to member inquiries via telephone, e-mail, or chat
Open, sort, and scan incoming claim and non-claim related mail
Complete timely and accurate entry of claims related data including the auditing, coding, and entry of claims
Maintain the required performance standards relating specifically to Customer Services and claims accuracy
Maintain files and databases as required by department policies and procedures
Coordinate inquiries requiring additional information with other departments in a cooperative, efficient, and professional manner
Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above
Foster, encourage, and reward a fun, positive, successful, values-based culture!