We Deliver the Right Solutions

Customer Service Representatives

Position: Customer Service Representatives
Location: Largo, MD

Job Description:

The net.AMERICA Corporation is seeking Customer Service Representatives to answer incoming member and provider calls in a timely and accurate manner to ensure questions and concerns are addressed. Ensure higher level concerns are directed to appropriate resources for assistance. Meet all required contractual and company goals and expectations.

Responsibilities included but not limited:

  • Service Dental members by communicating benefit information, providing information and resources necessary to understand benefit plan coverage, verify insurance coverage, and assist in locating providers.
  • Service Dental providers by communicating benefits, authorizations, claims, and eligibility information.
  • Utilize knowledge of claim adjustments and resubmission processes to determine appropriate resolution to provider requests.
  • Provide feedback to Provider Relations staff on high level claim issues including but not limited to issues with reimbursement schedules or conflicting information to ensure providers receive a prompt resolution.
  • Support enrollment activities including but not limited to updating eligibility, assigning primary care providers, and updating third party insurance information.
  • Act as liaison between our organization and the client’s Member Services staff to resolve issues such as eligibility and filing of appeals and grievances.
  • Provide updates to providers with questions regarding the status of their credentialing application.
  • Recognize provider questions that could be handled through the use of the provider web portal and provide education to these callers on the benefits of utilizing the technology available.
  • Ensure all calls are answered according to company and client guidelines.
  • Accurately document call information and resolution in internal systems while engaging with customer.
  • Utilize effective diffusion techniques when necessary to ensure proper resolution is reached.
  • Properly identify potential issues that are not easily resolved and escalate appropriately to Team Leads or Manager.
  • Perform outbound calling projects as directed.

Experience and Education Required:

  • High School Diploma
  • 1 -3 years of job related experience (heavy phone work, reception, call center etc.)

Additional Responsibilities:

  • Provide recommendations on system enhancements and process improvements to management.
  • Provide Provider Relations Representatives with potential updates to provider manual and training documents.
  • Participate in departmental projects when applicable.

Preferred Qualifications:

  • Experience in a Managed Care Organization
  • Experience with Medicaid and/or Medicare Benefit Administration
  • Experience with Medical or Dental Insurance
  • Knowledge of dental terminology and practices

Competencies:

  • Customer Orientation – Ability to demonstrate concern for satisfying one’s external and/or internal customers.
  • Critical Thinking – The ability to analyze/evaluate information as presented, utilize past experience to make decisions that are logical and reasonable and demonstrate sound judgment.
  • Listening – Technique to ensure a good understanding of another person’s message through focus on the speaker to ensure comprehension, retention and effective response.
  • Interpersonal Skills – The ability to notice, interpret, and anticipate others’ concerns and feelings, and to communicate this awareness empathetically to others.
  • Initiative – Identifying what needs to be done and doing it before being asked or before the situation requires it.

Start Date: On or about January 1, 2016