SDC - Claims and Customer Care Specialist
About the position
The Claims and Customer Care Specialist role at Medical Mutual involves processing routine to moderately complex claims while providing exceptional customer service through various communication channels. This position is integral to ensuring that members, providers, clients, and brokers receive timely and accurate assistance, contributing to the overall mission of delivering high-quality health insurance services.
Responsibilities
Process routine claims using multiple systems and applications while providing customer service via inbound call queues.
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Handle moderately complex claims and adjustments, responding to inquiries through various channels such as email and chat.
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Conduct claims research under the direction of senior staff and assist with projects as directed by management.
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Mentor and train junior team members, providing overflow and escalation support for customer service inquiries.
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Conduct complex claims research projects in response to escalations and inter-departmental inquiries.
Requirements
Associate degree in business or healthcare administration, communications, or related field, or equivalent combination of training and experience.
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1-5 years of customer service and/or claims experience, preferably in the health or dental insurance industry.
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Professional certifications such as Certified Dental Billing Specialist (CDBS), Certified Dental Coder (CDC), or Certified Dental Assistant (CDA) are a plus.
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Basic to advanced Microsoft Office skills depending on the level of the position.
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Knowledge of dental benefits, services, terminology, and American Dental Association coding.
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Understanding of standard customer service best practices and principles.
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Familiarity with the Health Insurance Portability and Accountability Act (HIPAA).
Nice-to-haves
Experience in a call center environment in the health or dental insurance industry.
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Advanced knowledge of dental benefits and coding practices.
Benefits
Employee bonus program.
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401(k) with company match up to 4% and additional company contribution.
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Health Savings Account with company matching contribution.
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Comprehensive medical, dental, vision, life, and disability insurance.
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Access to an Employee Assistance Program for counseling and coaching.
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Company holidays and up to 16 PTO days in the first year, with options to carry over unused PTO.
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Parental leave for eligible employees after 120 days of service.
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Career development programs and tuition reimbursement up to $5,250 per year.
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