Customer Service Representative

at DELTA DENTAL OF ILLINOIS in Naperville, Illinois, United States

Job Description

OVERVIEW OF POSITION: The Customer Experience Representative is responsible for providing service to the DDIL client base through effective verbal and written communication as well as troubleshooting and resolving all types of dental claim related inquiries. DUTIES & RESPONSIBILITIES: • Understanding of dental terminology. • Ability to use good judgment when applying dental knowledge when processing claims and handling client calls. • Accurately respond to verbal and written inquiries and complaints directly from subscribers, providers, brokers, or group administrators. • Accurately process claim adjustments during the phone call and/or during regular work time. • Review and process claims according to established business rules that have failed computer program edits. • Maintain and follow up on documents for all adjustment requests, check investigations, overpayment letters and e-forms. • Complete and maintain daily log/forms/reports. • Assist in new representatives' training. • Accurately completes special projects assigned within specified time frames. • Continued training in calls and claims with further progression based upon meeting performance requirements. • Accesses EPHI following the current guidelines as established at the company- wide and department levels. • Maintains regular attendance and punctuality. • Performs other job-related duties as assigned. • Ability to provide feedback to CS leadership or team members in order to contribute to one common goal.