Customer Service Representative I

Customer Service Representative
100% Remote
Pay: $23.98 per hour
26-08627
Job Summary

The Customer Service Representative provides professional, accurate, and timely support to customers, members, providers, and other stakeholders regarding dental insurance products and services. This role researches and resolves inquiries related to eligibility, benefits, claims, authorizations, coordination of benefits, and access to care through phone, email, web portal, and chat channels. The representative is responsible for documenting customer interactions, resolving complex issues, protecting service quality, and meeting individual, departmental, and client-specific performance goals.

Job Responsibilities

• Resolve coordination of benefits inquiries by reviewing enrollment, third-party liability, claims attachments, and related patient activity.
• Interpret and communicate accurate insurance coverage and benefit information.
• Educate customers and dental professionals regarding eligibility, benefits, claims payment, and authorizations.
• Research and resolve member and provider inquiries through phone, email, web portal, and chat.
• Research and resolve claims payment inquiries and determine appropriate actions.
• Assist members with accessing care by locating network dentists or facilitating assignment to a primary care dentist.
• Document all customer interactions accurately and completely.
• Provide guidance on self-service tools and available resources.
• Route inquiries to the appropriate department or individual when resolution is outside the scope of the role.
• Manage complex customer inquiries and establish clear expectations for follow-up.
• Ensure resubmissions, stop payments, and voids are processed appropriately.
• Maintain a courteous, professional, and customer-focused approach across all communication channels.
• Meet or exceed individual, departmental, and client-specific performance goals.
• Follow applicable administrative, contractual, compliance, and procedural requirements.
• Identify and recommend opportunities to improve service delivery processes.
• Perform other duties as assigned.

Job Requirements

• 2 years of experience in a high-volume customer service environment.
• 1 year of experience in the health insurance industry.
• Experience using multiple software applications simultaneously.
• Ability to set up computer equipment and troubleshoot basic issues with minimal assistance.
• Strong professional verbal and written communication skills.
• Proficiency using computers and Microsoft Office applications.
• Strong organizational skills and attention to detail.
• Critical thinking and problem-solving skills.
• Ability to work independently and collaboratively as part of a team.
• Ability to learn quickly and adapt to a fast-paced production environment.
• Ability to interact professionally and effectively with coworkers, staff, and visitors.
• Ability to perform repetitive work while maintaining accuracy and service levels.
• Ability to complete additional training as required.

Education

• High school diploma or equivalent required.

About Equiliem

Equiliem believes in empowering success. It's our job to cultivate relationships that connect people and employers in a way that is inclusive, intelligent, and allows both to thrive.

Across the U.S., leading companies in healthcare, government, engineering, manufacturing, professional services, and energy rely on us for their workforce solutions. Our recruiting and HR services include contract and direct hire staffing, Payrolling/EOR, Independent Contractor Compliance, and Managed Services.

For almost 30 years, we've helped shape our industry. Today, we continue to research, ask questions, and continuously enhance the candidate journey and client experience.

Benefits

We offer a comprehensive benefits package to our employees, which includes:

• Medical Insurance
• Vision & Dental Insurance
• Life Insurance
• Matching 401(k)
• Commuter Benefits
• Employee Discounts & Rewards
• Payroll Payment Options

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Equiliem is an equal opportunity employer. We do not discriminate or allow discrimination based on race, color, religion, creed, sex, age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Equiliem will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [emailprotected] or (732) 238-6050.