Customer Service Representative

POSITION SUMMARY

Under the supervision of the Customer Service Manager, responds to customer inquires and resolves customer issues, and provides information about eligibility, benefits, and claims information during incoming/outbound calls or walk-ins and within written or electronic correspondence. Coordinates benefits with other insurance carriers and processes simple claim adjudication, as well supports Claims Processing with data entry and claims up to Level 2. Responds to all inquiries and resolves issues in an efficient and timely manner, as established by Team Goals and Objectives.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Responds to phone inquiries regarding eligibility, benefits, claim status, and other plan information and/or issues in an efficient and timely manner.
• Coordinates benefits with Medicaid and other insurance carriers by phone and processes simple claim adjudication when necessary.
• Provides written responses to Customer Care emails.
• Provides back-up support for Claims Processing with data entry and adjudicate claims up to Level 2 as required.

Other Duties & Responsibilities

• Adheres to established document policies and procedures.
• Accomplishes special projects as assigned.
• Completes routine administrative tasks.
• Services walk-in customer inquiries.
• Other miscellaneous duties and responsibilities as assigned.

MINIMUM QUALIFICATIONS AND EXPERIENCE

Education

High School Diploma, or its equivalent.

Experience

• At least one year clerical experience, customer service or sales, or any combination of education and experience which would provide the necessary knowledge, skills and abilities to meet the minimum qualifications to perform the essential functions of this position.
• Preferred experience working in a high call volume work setting.

Skills and Knowledge:

• Working knowledge of PC applications (i.e. word processing and spreadsheets) highly desirable.
• Requires demonstrated customer service skills and sales ability.
• Ability to maintain focus, attention to detail, and a willingness to own and follow-up with tasks.
• Ability to handle multiple tasks with some distractions while maintaining a high level of accuracy.0/03/2013
• Ability to communicate orally and in writing with all levels of staff, customers and vendors.
• Ability to handle all information in a confidential manner and in compliance with federal and state laws/regulations (i.e., HIPAA, PHI).

Note: The above information on this description has been designed to indicate the general nature and level of work performed by an employee in this classification. It is not to be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications of employees assigned to this job. Hawaii Dental Service has the right to add to, revise, or delete information in this description. Reasonable accommodations will be made to enable qualified individuals with disabilities to perform the essential functions of this position.