Description
The SDC - Claims/Customer Care Specialist - TPA position allows you the flexibility to work at home as long as you reside within a 50-mile radius of the Brooklyn, OH or Centerville, OH Medical Mutual offices.
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans.
Medical Mutual' s status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us and help our members achieve their best possible health and quality of life.
In this blended role, processes routine to moderately complex claims, while handling inbound calls and written inquiries (multiple channels) from members, providers, clients, employers, and brokers, in accordance with established performance expectations, service philosophy, and service level agreements.
Responsibilities
SDC-Claims/Customer Care Specialist I
· Utilizing multiple systems, applications, and reference tools, processes routine claims, while providing customer service via inbound call queues.
· Performs other duties as assigned.
SDC-Claims/Customer Care Specialist II
· Utilizing multiple systems, applications, and reference tools, processes routine to moderately complex claims and adjustments, while providing customer service via inbound call queues and various channels of written communications (such as email, chat, and portal inquiries).
· Under direction of more senior staff, conducts claims or inquiry related research.
· Assists with projects as directed by management.
· Performs other duties as assigned.
SDC-Sr. Claims/Customer Care Specialist
· Utilizing multiple systems, applications, and reference tools, processes routine to complex claims and adjustments, while providing customer service via inbound call queues and all channels of written communications (such as email, chat, and portal inquiries).
· Conducts and responds to complex claims research projects in response to inter/intra-departmental inquiries and escalations.
· Provides trouble shooting.
· Serves as a peer mentor/trainer for team members and initiates and provides input for process improvements.
· Assists with projects as directed by management.
· Performs other duties as assigned.
SDC-Lead Claims/Customer Care Specialist
· Serves as a mentor, trainer, and coach for junior members of the claims/customer care team.
· Utilizing multiple systems, applications and reference tools, processes complex claims and adjustments, while providing overflow and escalation support to customer service via inbound call queues and all channels of written communications (such as email, chat, and portal inquiries).
· Conducts and responds to complex claim and call trend research projects in response to inter/intra-departmental inquiries and escalations, or direction from leadership.
· Assists with inventory management and call coverage monitoring.
· Performs other duties as assigned.
Qualifications
Qualifications
SDC-Claims/Customer Care Specialist I
Education and Experience:
· Associate degree in business or healthcare administration, communications or related field or equivalent combination of training and experience.
· 1 year customer service and/or claims experience, preferably in a call center in the health or dental insurance industry or dental providers office.
Professional Certification(s):
· Certified Dental Billing Specialist (CDBS), Certified Dental Coder (CDC), or Certified Dental Assistant (CDA) a plus.
Technical Skills and Knowledge:
· Basic Microsoft Office skills.
· Basic knowledge of dental benefits, services, terminology, and American Dental Association coding.
· Knowledge of standard customer services best practices and principles.
· Knowledge of Heath Insurance Portability and Accountability Act (HIPAA).
SDC-Claims/Customer Care Specialist II
Education and Experience:
· Associate degree in business or healthcare administration, communications or related field or equivalent combination of training and experience.
· 2 years of experience as a Claims/Customer Care Specialist or equivalent customer service experience, preferably in dental insurance, dental providers office, or the healthcare/health insurance industry.
Professional Certification(s):
· Certified Dental Billing Specialist (CDBS), Certified Dental Coder (CDC), or Certified Dental Assistant (CDA) a plus.
Technical Skills and Knowledge:
· Basic to intermediate Microsoft Office skills.
· Solid knowledge of dental benefits, services, terminology, and American Dental Association coding.
· Knowledge of standard customer services best practices and principles.
· Knowledge of Heath Insurance Portability and Accountability Act (HIPAA).]
SDC-Sr. Claims/Customer Care Specialist
Education and Experience:
· Associate degree in business or healthcare administration, communications or related field or equivalent combination of training and experience.
· 3 years of experience as a Claims/Customer Care Specialist or equivalent customer service experience, preferably in dental insurance, dental providers office, or the healthcare/health insurance industry.
Professional Certification(s):
· Certified Dental Billing Specialist (CDBS), Certified Dental Coder (CDC), or Certified Dental Assistant (CDA) a plus.
Technical Skills and Knowledge:
· Intermediate to advanced Microsoft Office skills.
· Strong knowledge of dental benefits, services, terminology, and American Dental Association coding.
· Strong knowledge of standard customer services best practices and principles.
· Knowledge of Heath Insurance Portability and Accountability Act (HIPAA).
SDC-Lead Claims/Customer Care Specialist
Education and Experience:
· Associate degree in business or healthcare administration, communications or related field or equivalent combination of training and experience.
· 5 years progressive experience as a Claims/Customer Care Specialist, or equivalent customer service experience, preferably in dental insurance, dental providers office, or the healthcare/health insurance industry.
Professional Certification(s):
· Certified Dental Billing Specialist (CD552BS), Certified Dental Coder (CDC), or Certified Dental Assistant (CDA) a plus.
Technical Skills and Knowledge:
· Intermediate to advanced Microsoft Office skills.
· Strong knowledge of dental benefits, services, terminology, and American Dental Association coding.
· Strong knowledge of standard customer services best practices and principles.
· Knowledge of Heath Insurance Portability and Accountability Act (HIPAA).
Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:
A Great Place to Work:
- We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
- Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
- On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
- Discounts at many places in and around town, just for being a Medical Mutual team member.
- The opportunity to earn cash rewards for shopping with our customers.
- Business casual attire, including jeans.
Excellent Benefits and Compensation:
- Employee bonus program.
- 401(k) with company match up to 4% and an additional company contribution.
- Health Savings Account with a company matching contribution.
- Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
- Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
- Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
- After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.
An Investment in You:
- Career development programs and classes.
- Mentoring and coaching to help you advance in your career.
- Tuition reimbursement up to $5,250 per year, the IRS maximum.
- Diverse, inclusive and welcoming culture with Business Resource Groups.
About Medical Mutual:
Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.
There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.
We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
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