Customer Care Rep II - Fully Remote!

About Our Client:

The organization operates within the healthcare insurance sector, focusing on dental and vision coverage. It addresses the challenges customers face in understanding eligibility, benefit coverage, and claims processing by providing dedicated support services. The program manages a broad range of inquiries and assists both members and providers, contributing to customer satisfaction and provider relations.

About the Opportunity:

The Customer Care Rep II role is designed to deliver clear, empathetic, and effective customer service to individuals seeking assistance with dental and vision insurance benefits. The position plays a critical role in resolving member and provider inquiries, supporting enrollment activities, and facilitating communication between providers and Member Services. This role ensures that customers receive accurate information and that provider issues are addressed promptly, contributing to the organization’s service quality and operational efficiency.

Responsibilities:

• Handle inbound calls regarding eligibility, benefits, authorizations, claims, and provider location assistance for dental and vision plans.
• Resolve provider requests related to claim adjustments and resubmissions.
• Communicate high-level claim issues to Provider Relations for timely resolution.
• Support enrollment tasks such as assigning primary care providers and updating insurance information.
• Liaise between the organization and Member Services to resolve eligibility issues and manage appeals and grievances.
• Provide updates to providers about credentialing application status.
• Educate providers on using the web portal for common inquiries.
• Ensure all calls meet company and client standards.
• Accurately document call details and resolutions in internal systems.
• Use effective techniques to ensure customers feel heard and supported.
• Identify and escalate issues to leadership when appropriate.
• Recommend system and process improvements.
• Keep Provider Relations informed of discrepancies or changes affecting providers.
• Participate in departmental projects as needed.

Requirements:

• High school diploma or equivalent.
• Minimum 1 year of customer service experience, preferably in healthcare, call centers, banking, or retail.
• Basic proficiency with Microsoft Office (Word, Excel, Outlook).
• Ability to work occasional overtime.
• Strong listening, communication, and empathy skills.
• Proficient data entry and typing skills.
• Strong navigation and multitasking abilities.
• High attention to detail.
• Critical thinking to analyze requests and provide appropriate solutions.
• Preferred: 1+ year customer service experience in dental, vision, or medical insurance.
• Preferred: Experience working virtually.
• Preferred: Familiarity with dental, vision, or medical insurance terminology.

Pay Range and Compensation Package:

• The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, and other relevant factors.

Benefits & Perks:

• $2.00/hour differential on Mondays and Tuesdays.
• Fully remote position.
• Training schedule from 8:00am to 4:30pm CST for first 12 weeks.
• Work schedule post-training from 10:30am to 7:00pm CST, Monday through Friday.
• Potential for occasional evenings, weekends, and holidays during Annual Medicare Open Enrollment (October 1 to March 31).
• Opportunities for professional growth in a rewarding environment.

Equal Opportunity Statement:

Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.

Note:

RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.