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Operations Analyst

4 months ago

Providence, United States Delta Dental of Rhode Island Full time
Job DescriptionJob Description

POSITION SUMMARY: This position is a hybrid role working with both the Operations and Customer Service departments. In this role, the analyst will process daily eligibility files, enter eligibility information into our member portal, respond to e-mails and answer inquiries from groups, brokers, members and dental offices.

Essential Functions:

Customer Service

  • Responds to current and prospective customers' questions and complaints/appeals in a timely, empathetic manner that come into the Customer Service Department via telephone or Web inquiries. An effective response may require researching the claim and coordinating information from other departments within Company.
  • Responsible for the research of complaints, appeals, claim processing issues, benefit and eligibility requests and all communication with the customer.
  • Works with Operations staff to review claims and re-visit the original decision regarding payment.
  • Answers inquiries from dental office personnel to clarify subscriber’s coverage level, identify allowance procedures and resolve claim payment issues.
  • Responsible for building a strong rapport with dental office staff, groups and members to ensure a positive perception of Delta Dental and Altus Dental Insurance.

Enrollment/Billing

  • Manages daily electronic eligibility files. This includes monitoring, reviewing and reconciling. This also includes working with vendor/group on any issues found during reconciliation process.
  • Responsible for entering eligibility information received through USPS Mail, Fax, Email into the online enrollment portal.
  • Answers inquiries made by groups, brokers and Customer Service related to eligibility/billing including new subscribers, changes & terminations.
  • Runs ID card process and ensures timely mailing.
  • Assists in the processing of the Premium Bill Run and Cost Plus Bill Run.

Testing

  • Assists in the evaluation of all system releases to ensure accuracy and completion.
  • Participates in functional training for new core processing system.

Other Duties

  • Participates in special projects as required by management
  • Performs other duties as assigned

Requirements:

  • High School Diploma or equivalent; Associates or Bachelor’s degree preferred.
  • Excellent communication and organizational skills.
  • Attention to detail and accuracy.
  • Bilingual strongly preferred.
Hybrid Work Schedule: up to 2 days remote/3 days in office