Medical Benefits Customer Service Representative
Action Personnel, Inc., Roanoke, VA, United States
Medical Benefits Customer Service Representative
We are seeking a professional and customer-focused Medical Benefits Customer Service Representative to handle incoming inquiries related to benefits, claims, and provider support. The ideal candidate is patient, detail-oriented, and able to communicate clearly with subscribers, dental providers, and group administrators. Responsibilities
Answer telephone calls from subscribers, providers, and group administrators in a courteous and professional manner Provide information regarding eligibility, dental benefits, coverage levels, and frequencies Explain how claims are processed and paid Resolve claim issues, complete corrections, and monitor adjudication adjustments Submit claims to Professional Review when an appeal is requested Issue ID cards as needed Provide participating dentist names and office locations Respond to written correspondence Make address changes and update member information Return calls to subscribers and providers in a timely manner Enter detailed comments after each call Route calls to the appropriate department when necessary Explain the appeals process and assist with next steps Perform additional duties as assigned to support business needs Qualifications
High school diploma or GED required Minimum of one year of prior customer service experience Proficient with PCs, office equipment (copier, fax), and data entry Excellent verbal and written communication skills Ability to communicate professionally with diverse customers Strong interpersonal skills and problem-solving abilities Preferred: experience with medical or dental insurance and/or call center environments
We are seeking a professional and customer-focused Medical Benefits Customer Service Representative to handle incoming inquiries related to benefits, claims, and provider support. The ideal candidate is patient, detail-oriented, and able to communicate clearly with subscribers, dental providers, and group administrators. Responsibilities
Answer telephone calls from subscribers, providers, and group administrators in a courteous and professional manner Provide information regarding eligibility, dental benefits, coverage levels, and frequencies Explain how claims are processed and paid Resolve claim issues, complete corrections, and monitor adjudication adjustments Submit claims to Professional Review when an appeal is requested Issue ID cards as needed Provide participating dentist names and office locations Respond to written correspondence Make address changes and update member information Return calls to subscribers and providers in a timely manner Enter detailed comments after each call Route calls to the appropriate department when necessary Explain the appeals process and assist with next steps Perform additional duties as assigned to support business needs Qualifications
High school diploma or GED required Minimum of one year of prior customer service experience Proficient with PCs, office equipment (copier, fax), and data entry Excellent verbal and written communication skills Ability to communicate professionally with diverse customers Strong interpersonal skills and problem-solving abilities Preferred: experience with medical or dental insurance and/or call center environments