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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in customer service within the Dental, Medical, or Managed Care industry, with strong communication, organizational, and problem-solving skills. Proficient in navigating multiple systems and achieving performance metrics in a call center environment.
Highest-signal resume keywords
Customer Service ExperienceCall Center ExperienceKnowledge of Dental BenefitsProficiency in Microsoft WordEffective Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Customer Service AssessmentTyping SkillsProblem-Solving SkillsAnalytical SkillsTime Management Skills
Soft Skills
Organizational SkillsVerbal Communication SkillsWritten Communication Skills
Tools & Technologies
Microsoft OutlookInternet Explorer
Certifications & Qualifications
High School DiplomaGEDCollege Degree
Industry Keywords
Dental IndustryMedical IndustryManaged CareClaimsEligibility
About the role
Key responsibilities & impact- Respond to inbound inquiries regarding dental benefits, eligibility, claims, appeals, grievances, and provider searches for Commercial and Medicare plans
- Interpret and clarify dental benefits, policies, and procedures for members, providers, and employer groups
- Investigate and resolve member or provider concerns by contacting appropriate parties and accurately documenting interactions in the billing system
- Investigate verbal complaints regarding billing, claims, or services rendered
- Escalate service failures to appropriate internal departments for follow-up and resolution
- Retrieve and send written correspondence, plan brochures, provider directories, and other printed materials
- Meet or exceed ACD call-volume and quality-performance goals
- Achieve assigned individual monthly performance metrics
- Maintain current knowledge of Member Services policies, procedures, and dental plan updates
- Perform additional duties assigned by management
Requirements
What you’ll need- High school diploma, GED, or college degree
- 1 year of face-to-face customer service experience
- At least 1 year of call center experience preferred
- Customer service assessment and typing test
- Knowledge and prior experience in the Dental, Medical, or Managed Care industry preferred
- Proficiency in Microsoft Word, Microsoft Outlook, and Internet Explorer
- Effective communication skills over the phone
- Strong organizational, time management, written and verbal communication, analytical, and problem-solving skills
- Ability to deal with problems involving several concrete variables in standardized situations
- Successful completion of background check required
- Successfully complete mandatory paid training with 100% attendance
- Home internet connection with 10 Mbps download and 3 Mbps upload speed
- Ability to hardwire the work computer directly to the home modem via Ethernet; satellite and wireless internet are not acceptable
- Distraction-free and secure home workspace
- Ability to successfully navigate 6 systems and average 32 calls per day
Benefits
Comp & perks- Medical, dental and vision benefits available on the 1st day of employment
- Paid time off accrued after 180 days of employment
- Paid training program
- Employer-provided computer, monitor, mouse, keyboard, headset, Ethernet cord, and power cables
- Potential bonus or incentive based on business need
- Health insurance coverage
- Voluntary dental and vision programs
- Life and disability insurance
- Retirement savings plan
- Paid holidays
- Paid time off or vacation and/or sick time
- Growth opportunities within the healthcare team