Lead Dental CS Rep

Let’s do great things, together!

About Moda
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Position Summary
Provide customer service to members on a wide range of plan types in multiple states. Plan types include Commercial, Individual, Performance Guarantee (PG) and Oregon Health Plan (OHP). Analyze customer needs by providing timely and accurate responses. Answer calls from policyholders, members, agents, providers, and others regarding benefits or other issues. Supports CSR’s, supports supervisor with questions, coaching, handles escalations, training and reports. This is FT WFH role. 


Pay Range
$25.08- $31.35 ​​​hourly (depending on experience)

Please fill out an application on our company page, linked below, to be considered for this position.

https://j.brt.mv/jb.do?reqGK=27739209&refresh=true


Benefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Required Skills, Experience & Education:

1. High school diploma or equivalent.
2. Knowledge of dental terminology.
3. 1 -2 years of experience as a Delta Dental customer service representative providing customer service on multiple types of benefit plans or equivalent work experience.
4. Working knowledge of all plan types handled by the department.
5. Ability to handle stressful situations.
6. Ability to organize and prioritize work.
7. Strong verbal, written, and interpersonal communication skills.
8. Strong analytical, problem-solving and decision-making skills with demonstrated ability to handle and resolve complaints, correct errors, and resolve issues with little assistance.
9. Ability to communicate positively, patiently, and courteously with internal and external customers.
10. Work well under pressure with frequent interruptions and shifting priorities.
11. Ability to back up supervisor, answer questions from other representatives, assist in training or orientation and complete reports.
12. Demonstrated ability to consistently comply with company rules and policies.
13. Ability to maintain confidentiality and project a professional business image.
14. Ability to come to work on time and on a daily basis.
15. 10-key proficiency of 105 kspm net on a computer numeric keypad.
16. Type a minimum of 25 wpm net on a computer keyboard.
17. Ability to effectively navigate the internet, as well as multiple databases and informational screens.

 

Primary Functions:

1. Provide support to department supervisors. This includes assessing performance, phone monitoring, training, handles questions for CSR I, II & IIIs.
2. Handle difficult telephone calls and contract issues.
3. Provide accurate information in a professional manner.
4.  Aid in responding to calls that come in for the Supervisor.
5. Ensure that Supervisor is aware of CSR feedback within unit.
6. Monitor phone dashboard and daily schedule to determine if more phone coverage is needed.
7. Provide backup phone coverage as needed or requested by supervisor.
8. Ability to repeatedly analyze situations, communicate effectively in a fast-paced environment that can include dealing with difficult situations.
9. Assist Sales and Account Services by presenting customer service demonstrations or making service calls.
10. Provide back up to Dental Customer Service Trainer as needed.
11. Apply mathematical skills to determine correct benefit information.
12. Works with Membership Accounting to resolve eligibility and premium issues for Individual members
13. Exercise judgement, initiative, and discretion in confidential and sensitive manners.
14.  Provide customer service to walk-in customers when working in the office.
15. Review, update and become familiar with new and revised benefit information or claim processing procedures.
16. Answer claim benefit questions on both group and individual products. Provide solutions to problems, confirm eligibility, explain benefits and/or plan coverage.
17. Create documents as assigned for members and/or providers.
18. Create new and review existing Policy and Procedures.
19. Handle queries for reporting purposes.
20. Other duties as assigned

Working Conditions & Contact with Others

• Work from home environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Must be able to find benefit information on multiple groups and plans.  Ability to change schedule with short notice to ensure lead coverage and work in excess of standard work week as business needs warrant.
• Internally: Claims, Sales and Account Services, Benefit Configuration, Provider Relations, Membership Accounting, OHP Coordinators and Grievance and Appeals Team. Externally: Members, providers, brokers, government programs and other insurance companies. May serve on committees and work with Managers, Directors, or Vice Presidents on special projects, policyholder calls, demos, etc.
   

 

Together, we can be more. We can be better.
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Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. 

For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our humanresources@modahealth.com email.

Salary : $25 - $31