Member Services Representative

Dection Staffing Services

Decton Inc. is currently recruiting for a company in Irvine, CA! Currently seeking Member Service Representatives. If qualified, please submit your resume and contact Liz directly @ (949)421-6006 (Call or Text)

Member Services Representative is expected to provide excellent customer service to all incoming/outgoing callers and answer and document inquiries related to dental benefits, eligibility, provider information, claims, pre-estimates/pre-authorizations, grievance and appeals, fulfillment requests and other miscellaneous inquiries.

  • Maintain a quality score of 95% or greater.
  • Review and respond to all email communications no later than 24 hours from receipt.
  • Conduct outbound calls and/or campaigns when directed.
  • Thoroughly document all customer transactions in host system.
  • Adhere to scheduled shifts to ensure optimal phone coverage.
  • Ensure compliance to all regulatory guidelines.
  • Safeguard and secure all PHI from misuse in strict accordance with Information Security Policies and Procedures.
  • Follow safety guidelines outlined by Plan’s Illness and Injury Prevention Program (IIPP).

Education and/or Experience:

  • Minimum requirements include a high school diploma or GED.
  • One year of customer service experience in a call center environment preferred.
  • Minimum two years dental healthcare experience, dental office, and/or dental insurance background required.

Specific Skills/Knowledge:

  • Excellent listening skills to appropriately handle calls
  • Excellent verbal and written communication skills
  • Outstanding customer service skills
  • Knowledge of dental terminology and practices
  • Minimum typing speed of 40 wpm
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