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;
Team player; ability to get along well with others and function as part of a work group;
Excellent data entry skills;
