Claims and Customer Care Specialist

About the position The SDC - Claims/Customer Care Specialist - TPA position at Medical Mutual offers a flexible work-from-home opportunity for individuals residing within a 50-mile radius of the Brooklyn or Centerville, OH offices. This role involves processing routine to moderately complex claims while providing customer service through various communication channels. The position is designed to support the company's mission of delivering high-quality health insurance services to over 1.6 million Ohioans, ensuring members achieve their best possible health and quality of life. Responsibilities • Processes routine claims while providing customer service via inbound call queues. , • Handles inbound calls and written inquiries from members, providers, clients, employers, and brokers. , • Conducts claims or inquiry related research under the direction of senior staff. , • Assists with projects as directed by management. , • Mentors and trains junior team members in claims processing and customer service. , • Conducts complex claims research projects in response to inquiries and escalations. , • Provides troubleshooting support for claims issues. Requirements • Associate degree in business or healthcare administration, communications or related field or 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 • Certified Dental Billing Specialist (CDBS), Certified Dental Coder (CDC), or Certified Dental Assistant (CDA) certification. Benefits • 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. Apply Job!