Note: The job is a remote job and is open to candidates in USA. Sun Life is a mission-driven organization focused on helping clients achieve lifetime financial security and live healthier lives. The Bilingual Customer Service Representative I will support members, providers, and internal stakeholders by resolving inquiries related to dental insurance coverage, eligibility, claims, and authorizations through phone, email, web portal, and chat.
Responsibilities
- Assist providers by resolving coordination of benefits inquiries through analysis of patient activity, including enrollment, third-party liability, and claims attachments
- Interpret and communicate accurate insurance coverage information based on a comprehensive understanding of relevant processes
- Thoroughly document all customer interactions in a complete and accurate manner
- Educate customers and dental professionals on eligibility, benefits, claims payment, and authorizations
- Guide customers on the usage and benefits of available self-service tools
- Assist members in gaining access to care by locating network dentists or facilitating assignment to a primary care dentist
- Route inquiries appropriately to the necessary departments or individuals when resolution falls outside the scope of this role
- Respond to customer inquiries in a courteous, timely, and professional manner across all communication channels
- Research and resolve complex internal and external member and provider inquiries via verbal and written communications
- Resolve claim payment inquiries by researching and analyzing patient activity and determining appropriate action
- Take ownership of issue resolution and set clear expectations for follow-up with customers
- Ensure resubmissions, stop payments, and voids are handled appropriately and in a timely manner
- Meet or exceed individual, department, and client-specific performance goals
- Understand and adhere to all administrative and contractual policies and procedures
- Contribute to organizational success by identifying and suggesting improvements to service delivery processes
- Perform other duties as assigned
Skills
- Fluency in Mandarin (written and spoken)
- Proven professional verbal and written communication skills in English and Mandarin
- Strong critical thinking and problem-solving abilities
- Excellent organizational skills and keen attention to detail
- Ability to work both independently and collaboratively within a team environment
- Ability to learn quickly and adapt to a fast-paced production environment
- Ability to efficiently operate a computer and navigate multiple software applications simultaneously
- Knowledge of Microsoft Office applications
- Ability to set up computer equipment and troubleshoot technical issues with minimal assistance
- Cooperative and professional interaction skills with co-workers, company staff, and visitors
- Ability to tolerate repetitive work without compromising accuracy or service levels
- Effective communication skills including the ability to convey complex information clearly and concisely
- Minimum of 2 years of experience in a high-volume customer service environment
- Minimum of 1 year of experience in the health insurance industry
- Experience utilizing multiple software applications simultaneously
- High School Diploma or equivalent required
- Must be available to attend additional training as requested or deemed necessary
- These opportunities are 100% remote within the U.S
- Candidates should be comfortable working in the following time zones: • Central or Eastern Time (CT/ET)
- Cantonese proficiency is a plus
- Medical or dental terminology knowledge preferred
- Medicare and Medicaid knowledge preferred
- Claims, billing, and coding experience preferred
- Experience with Cisco phone systems is a plus
Benefits
- 100% remote within the U.S.
- Medical, dental & vision
- Hospital plans
- 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
- Life Insurance (Company paid Basic Life and AD&D as well as voluntary Life & AD&D for the employee and dependents)
- Company paid short and long-term disability
- Health & Dependent Care Spending Accounts (HSA & DCFSA)
- Employee Assistance Program
- Time Off/Leave (PTO, Allegis Group Paid Family Leave, Parental Leave)
Company Overview
Company H1B Sponsorship