Remote Government Programs Support Specialist

Delta Dental of Michigan; Farmington Hills (MI); On-site; USD 36,000 - 48,000; Full time

Job summary

Delta Dental of Michigan, in Farmington Hills, MI, is hiring a Government Programs Customer Service Representative. The role supports member, client and provider inquiries across channels and ensures accurate benefit, eligibility and claims information is conveyed.

Strong attention to regulatory requirements and CRM documentation is essential. Candidates should have a high school diploma or equivalent, with an associate degree preferred, and at least two years of customer service experience in a

Qualifications

• Requires a high school diploma or equivalent; an associate’s degree is preferred.
• Two years of customer service experience in a setting using software to assist customers, preferably in a call center serving Medicare/ Medicaid enrollees.
• Demonstrated knowledge of personal computers and Windows software.
• Successful completion of customer service assessments with specified scores, with waivers under certain conditions.
• Ability to work an eight-hour schedule starting as early as 7:55 a.m. and ending as late as 11:00 p.m., Monday through Friday.
• Familiarity with documenting information in a CRM and adhering to regulatory requirements.

Responsibilities

• Promptly and professionally responds to member, client and provider questions through multiple channels, including telephone, email, fax and U.S. mail.
• Clearly communicates eligibility, benefit, claim status and payment information related to caller questions.
• Identifies the reason for the call and provides appropriate resolution within regulatory guidelines and client contracts.
• Informs and assists callers with grievance and the claims appeals processes, as necessary.
• Documents information in the customer relationship management system to capture relevant details of the call.
• Adheres to regulatory requirements and meets quality standards and call center metrics.
• Enters and adjusts claims as required.

Skills

Customer service

Communication skills

PC proficiency

Multitasking

Call center experience

Education

High school diploma or equivalent

Associate degree in business administration or related field

Tools

Windows

Job description

Delta Dental of Michigan, in Farmington Hills, MI, is hiring a Government Programs Customer Service Representative. The role supports member, client and provider inquiries across channels and ensures accurate benefit, eligibility and claims information is conveyed.

Strong attention to regulatory requirements and CRM documentation is essential. Candidates should have a high school diploma or equivalent, with an associate degree preferred, and at least two years of customer service experience in a