Customer Service Representative

Please note that this is a contract role to provide services to Sun Life Financial (“Sun Life”) as an employee of Allegis Global Solutions (AGS). If you are selected for this role, you will be employed by AGS and will not be an employee of Sun Life.

Sun Life recognizes the unique talent which contingent workers bring to its organization. As an employee of AGS, you will have access to opportunities to provide services to Sun Life and contribute to Sun Life’s Purpose of helping Clients achieve lifetime financial security and live healthier lives. Sun Life’s values shape how we work: caring, authentic, bold, inspiring, and impactful. As a contingent worker at Sun Life, you’ll work alongside passionate colleagues and empowering leaders who will support your growth and celebrate your contributions. Bring your unique expertise to an innovative, flexible, and collaborative organization, where you’ll drive meaningful change.

Job Summary

We are seeking a dedicated and detail-oriented professional to join our customer service team, serving as a primary point of contact for members, providers, and other stakeholders across multiple lines of business. In this role, you will handle a high volume of inquiries through various communication channels — including phone, email, web portal, and chat — delivering accurate information and timely resolutions related to dental insurance coverage, eligibility, claims, and authorizations. You will project a professional company image at all times while providing superior service that supports both our customers and the overall success of the organization.

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 necessary departments or individuals when resolution falls outside the scope of this role
• Respond to all 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 learn quickly and adapt to a fast-paced, high-volume production environment
• Ability to manage and operate multiple software applications simultaneously
• Proficiency with Microsoft Office applications
• Ability to set up computer equipment and troubleshoot technical issues with minimal assistance
• Cooperative and professional interaction skills with co-workers, staff, and external contacts
• Ability to maintain accuracy and service levels while performing repetitive tasks
• Knowledge of medical or dental terminology (preferred)
• Familiarity with Medicare and Medicaid programs (preferred)
• Experience with claims, billing, and coding (preferred)
• Experience with Cisco phone systems (preferred)

Experience

• Minimum of 2 years of experience in a high-volume customer service environment
• At least 1 year of experience in the health insurance industry
• Experience utilizing multiple software …