Work from Home Customer Care Representative-Remote – Hiring in US

Are you looking for a career where you can apply your experience and passion for providing world class service to help our customers find solutions to their questions, if the answer is yes, then you found the perfect fit!

What you’ll do:

  • Servicing our Dental, Medical and Vision callers with information regarding their eligibility, benefit coverage, authorizations, claims, and assisting them with locating a provider in their area,
  • 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 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 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 our internal systems.
  • Apply effective diffusion techniques when necessary to ensure our customers feel heard, valued and supported.
  • Properly identify issues that need to be escalated appropriately to the leadership team.

Additional Responsibilities:

  • Provide recommendations on system enhancements and process improvements to management.
  • Keep our Provider Relations team updated with provider manual discrepancies, change in locations or any other provider related issues.
  • Participate in departmental projects when applicable.

What you should have:

  • Required Level of Education, Licenses, and/or CertificatesHigh school diploma or equivalent.
  • Required Level of Experience1 -3 years of job related experience (heavy phone work, reception, call center etc.)
  • Required Knowledge, Skills, and AbilitiesBasic knowledge of Microsoft Office products including but not limited to Word, Excel, and Outlook.
  • Ability to work an 8-hour shift between the hours of 6 am and 8 pm central time.
  • Ability to work occasional overtime as needed.
  • Excellent listening and communication skills
  • Superior customer service skills including the natural ability to provide empathy  
  • Strong data entry/typing skills
  • Strong navigation skills and the ability to multi-task
  • Excellent attention to detail
  • Critical thinking skills to quickly analyze and clearly understand a specific request or customer need and then leverage knowledge and resources to provide the appropriate solutions.


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