Dental CS Rep I

Moda Health•Portland, OR

12h•Remote

About The Position

Provide customer service to members of multiple benefit plans by analyzing the caller’s needs and by providing timely and accurate responses. Answer calls from policyholders, agents, members, providers, and others regarding benefits, eligibility, claims, premiums, or other issues. This is a full-time work from home position.

Requirements

High school diploma or equivalent.
Prior customer service experience, other related experience such as medical/dental office experience, or customer support experience.
Strong reading, verbal and written communication skills.
Ability to interact professionally, patiently, and courteously with customers over the phone.
Good analytical, problem solving and decision-making skills.
10-key proficiency of 105 kspm net on a computer numeric keypad.
Type a minimum of 35 wpm net on computer keyboard.
High speed internet (cable or fiber)
Must be proficient with Microsoft Office applications with the ability to open and navigate multiple windows at the same time.
Ability to achieve and maintain quality standards.
Ability to work well and independently under pressure in a complex and rapidly changing environment.
Ability to meet the attendance and punctuality policy of Moda Health.
Ability to remain focused and on task in a work from home environment.
Maintain confidentiality and project a professional business presence and appearance.
Ability to repeatedly analyze situations and communicate effectively in a fast-paced environment that includes dealing with escalating queries and concerns.
Ability to organize and remain up to date on changing and new information.
Ability to troubleshoot and follow protocols for reporting internet or technological issues.

Nice To Haves

Practical knowledge of medical or dental terminology preferred but not required.
Knowledge of diagnosis and procedure coding preferred but not required.

Responsibilities

Answer a high volume of inbound phone calls regarding dental claims, benefits, premiums, and eligibility involving employer groups, Oregon Health Plan (OHP) and Individual products.
Provide solutions to problems, confirm eligibility, explain benefits and/or plan coverage.
Provide accurate information in a professional manner.
Apply mathematical skills to determine correct benefit information and premium amounts for Individual plans.
Exercise judgement, initiative, and discretion in confidential and sensitive matters.
Follow HIPAA guidelines to protect member health information.
Document all aspects of a call in a clear and concise manner.
Keep up to date on new and revised benefit information, claim processing procedures, or system updates.
Gather banking details so monthly premium for members on Individual plans can be collected.
Identify and request claim adjustments when necessary.
Resolve and record complaints, appeals, and inquiries.
Contact providers, other insurance companies or state agencies when necessary to answer questions and obtain or provide information.
Provide timely follow-up and return calls within department guidelines.
Answer calls within service level time.
Perform other duties as assigned by Manager/Supervisor/ Lead.