Experienced Claims and Customer Care Specialist – Health Insurance Services

At careerzynith, we're dedicated to delivering exceptional health insurance services to over 1.6 million Ohioans, empowering them to achieve their best possible health and quality of life. As a Claims and Customer Care Specialist, you'll play a vital role in supporting our mission by providing top-notch customer service and processing routine to moderately complex claims. If you're passionate about the healthcare industry and possess excellent communication skills, we encourage you to join our team.

• *About careerzynith**

careerzynith is a leading health insurance provider in Ohio, committed to making a positive impact on the lives of our members. With a strong focus on customer satisfaction and quality service, we strive to create a work environment that fosters growth, innovation, and collaboration. Our team is comprised of dedicated professionals who share a common goal: to deliver exceptional health insurance services that exceed our members' expectations.

• *Responsibilities**

As a Claims and Customer Care Specialist, you'll be responsible for:

• Processing routine claims while providing exceptional customer service via inbound call queues, ensuring timely and accurate resolution of member inquiries.
• Handling inbound calls and written inquiries from members, providers, clients, employers, and brokers, providing clear and concise information on claims and benefits.
• Conducting claims or inquiry-related research under the direction of senior staff, utilizing your analytical skills to resolve complex issues.
• Assisting with projects as directed by management, demonstrating your ability to adapt to changing priorities and deadlines.
• Mentoring and training junior team members in claims processing and customer service, sharing your expertise and knowledge to enhance their skills.
• Conducting complex claims research projects in response to inquiries and escalations, utilizing your problem-solving skills to resolve issues efficiently.
• Providing troubleshooting support for claims issues, ensuring that members receive prompt and effective resolution.

• *Requirements**

To be successful in this role, you'll need:

• An Associate degree in business or healthcare administration, communications, or a related field, or an equivalent combination of training and experience.
• 1-5 years of customer service and/or claims experience, preferably in a call center in the health or dental insurance industry.
• Basic to advanced Microsoft Office skills, depending on the level of the position.
• Knowledge of dental benefits, services, terminology, and American Dental Association coding.
• Understanding of standard customer service best practices and principles.
• Knowledge of the Health Insurance Portability and Accountability Act (HIPAA).

• *Nice-to-Haves**

While not required, the following certifications are highly desirable:

• Certified Dental Billing Specialist (CDBS)
• Certified Dental Coder (CDC)
• Certified Dental Assistant (CDA)

• *Benefits**

As a valued member of our team, you'll enjoy a comprehensive benefits package, including:

• Employee bonus program
• 401(k) with company match up to 4% and additional company contribution
• Health Savings Account with company matching contribution
• Excellent medical, dental, vision, life, and disability insurance
• Access to an Employee Assistance Program for counseling and coaching
• Company holidays and up to 16 PTO days in the first year, with options to carry over unused PTO
• Parental leave for eligible employees after 120 days of service
• Career development programs and classes
• Tuition reimbursement up to $5,250 per year

• *Work Environment and Company Culture**

At careerzynith, we're committed to creating a work environment that's inclusive, supportive, and collaborative. Our team is comprised of dedicated professionals who share a passion for delivering exceptional health insurance services. We offer flexible work arrangements, including remote work options, to ensure that our team members can balance their work and personal life effectively.

• *How to Apply**

If you're passionate about the healthcare industry and possess excellent communication skills, we encourage you to apply for this exciting opportunity. Please submit your resume and a cover letter outlining your experience and qualifications. We can't wait to hear from you!

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