Member Service Representative

Title:  Member Engagement Representative
Pay: $50K
Direct Hire
Location: Worcester, MA
Schedule: Hybrid In-Office/Work from Home; Minimum designated 2 days per week in-office.

Overall Responsibility:  To deliver high quality customer service to doctors or doctor’s office staff, members, community partners and plan sponsor representatives in a professional, respective and helpful manner. Process claims in a timely, accurate manner.


Key responsibilities and accountabilities:

• Respond to inbound telephone calls, faxes and emails from doctors or doctor’s office staff, and plan sponsor representatives in a timely and professional manner;
• Respond to inbound telephone calls, faxes and emails from members or member representatives in a timely and professional manner;
• Process dental claims on system for all clients;
• Process claim corrections from daily EDI reports;
• Document communications with doctors and doctor’s office staff, and plan sponsor/employer representatives;
• Document communications with members and member representatives;
• Respond to claim inquiries from subscribers, doctors and plan sponsor/employer representatives in a timely and professional manner;
• Respond to benefit coverage inquiries from members and member representatives in a timely and professional manner;
• Respond to eligibility inquiries from subscribers, doctors and plan sponsor/employer representatives in a timely and professional manner;
• Maintain department productivity and quality expectations;
• Maintain knowledge of dental plan designs, exclusions, limitations and exceptions for each client;
• Adhere to all process and procedural guidelines;
• Any other duties as assigned

Skills and Attributes: 

• Ability to provide outstanding service
• Ability to work independently to achieve goals and objectives within defined timeframes
• Ability to process information through computer systems
• Ability to adjust priorities and manage time wisely in a fast-paced environment;
• Ability to communicate in a clear, concise, understandable manner, and listen attentively to others;
• Ability to prioritize and manage workflow;
• Ability to meet deadlines;
• Knowledge of CDT codes and dental terminology;
• Team player; ability to get along well with others and function as part of a work group;
• Excellent data entry skills;
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