Client Services Representative
Job Details
Experienced
Delta Dental of Illinois - Naperville, IL
Full Time
High School
None
Day
Customer Service
Description

OVERVIEW OF POSITION:

The Client Services 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:

  • Complete 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.
  • Access EPHI following the current guidelines as established at the company-wide and department levels.
  • Maintain regular and punctual attendance.
  • Perform other job-related duties as assigned.
Qualifications

EXPERIENCE & QUALIFICATIONS:

Strong customer service skills. Excellent oral and written communications skills. Strong computer keyboard skills and capable of working in an ACD environment with talk and work time goals. Knowledge of insurance reimbursement practices, i.e. processing policies, deductibles, maximums, Coordination of Benefits (COB) and dental terminology. Ability to multi-task. Excellent attendance and punctuality record. High School Diploma or Equivalent.

 

While not a requirement for the position, a preference is given to those who:

 

  • hold a State Producer’s License certification, or
  • can speak Spanish fluently, or
  • can make diagnostic determinations based on provider claim narratives, dental photos and radiographs
Apply