Note: The job is a remote job and is open to candidates in USA. Sun Life, through a contract arrangement with Allegis Global Solutions, supports clients' financial security and healthier lives. The Customer Service Representative will serve as a primary contact for members, providers, and dental professionals, handling inquiries about eligibility, benefits, claims, and authorizations across multiple communication channels while documenting interactions, resolving issues, and maintaining compliance with applicable policies.
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 accordance with established procedures
- Educate customers and dental professionals on eligibility, benefits, claims payment, and authorizations
- Guide customers on the usage and benefits of available self-service tools
- Help members gain 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, professional, and timely 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 corrective action
- Take ownership of issue resolution and set clear expectations for follow-up with customers
- Ensure resubmissions, stop payments, and voids are handled accurately and appropriately
- Meet or exceed individual, departmental, and client-specific performance goals
- Adhere to all administrative and contractual policies and procedures
- Contribute to continuous improvement by identifying and suggesting enhancements to service delivery processes
- Perform other duties as assigned
Skills
- Proven professional verbal and written communication skills
- Strong organizational skills and exceptional attention to detail
- Critical thinking and effective problem-solving abilities
- Ability to work both independently and collaboratively within a team environment
- Ability to manage multiple software applications simultaneously in a fast-paced setting
- Proficiency with Microsoft Office applications and general computer operation
- Ability to learn quickly and adapt to a high-volume production environment
- Ability to maintain accuracy and service levels while performing repetitive tasks
- Cooperative and professional interaction skills with colleagues, staff, and external contacts
- Ability to set up computer equipment and troubleshoot technical issues with minimal assistance
- 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
- Willingness to attend additional training as requested or deemed necessary
- Location: fully remote across the U.S.; however, candidates must be comfortable working PST hours to support the business requirements
- Medical or dental terminology knowledge preferred
- Medicare and Medicaid knowledge preferred
- Claims, billing, and coding experience preferred
- Experience with Cisco phone systems a plus
Benefits
- 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