Agent/CSR
Delta Dental/Medical-Dental
05.2022 - 11.2024
Responds to Dental Providers through telephone contact
- Researches inquiries by accessing the claims processing system and other informational sources
- Reviews subscribers coverage to determine type and level of benefits
- Claim status
- Check Providers Explanation Of Benefits
- Route to proper escalation department
- Troubleshoot technical issues
- Using all available tools
- Create accurate records of every customer transaction timely and professionally
- Update providers and members information following client guidelines
- Answer denials claim questions for providers/members
- Accuracy providing patient dental history
- Will guide and or go over manual of criteria with providers/members
- CRM-MMIS live chat calls
- Schedule Dentist appointments
- Create Tickets for improper claims
- Informed clients of policies and procedures.
- Assisted clients in navigating the claims process, ensuring timely resolution of issues and optimal outcomes.
- De-escalated and resolved customer complaints with punctual, polite and professional service.