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Benefit Plan Specialist

3 months ago

Naperville, United States Delta Dental Of Illinois Full time

**OVERVIEW OF POSITION**:The **Benefit Plan Specialist** is responsible for building benefit plans and maintaining new and existing claim processing business rules and limitations and policy tables as well as researching and analyzing system issues reported by internal staff in an accurate and efficient manner.

**DUTIES & RESPONSIBILITIES**:

- Coordinate activities with internal Enterprise stakeholders to ensure a seamless implementation for new accounts. Verify all pertinent information is received and completed.
- Build and maintain group benefit plan and policy tables in claim system for all new and renewing business in an accurate and efficient manner.
- Identify and analyze system problems and assist the on-site systems support staff in their solutions.
- Perform review and stakeholder acceptance testing of system enhancements as needed.
- Maintain claim processing procedure tables and policy tables as defined by DDIL policy, DDPA policy, Group agreements, and CDT and ICD updates.
- Provide expert knowledge and recommendations related to benefit plan design and assist in configuring benefit plan.
- Respond to written and oral inquiries from internal staff.
- Provide regular status updates for assigned tasks and projects to Immediate Team Leader, both orally and in writing.
- Complete duplication analysis as needed for marketing prospects.
- Review and process group requested changes, including but not limited to, benefit changes, claim processing inquiries, and/or duplication analysis according to established business policies and practices. This includes analysis of requested change, developing course of action and implementation of decision.
- Work closely with Professional Review to ensure we are following DDPA guidelines.
- Work directly with Account Managers on policy interpretation and implementation.
- Work directly with the Configuration Analysts to ensure accurate benefit plans and product administration.
- Assist in the implementation of new processes and processing procedures.
- Ensures mandated regulations such as health care reform, non-covered services and annual CDT additions, deletions and changes are consistently met.
- Work closely with Contract department to ensure contracts accurately reflect benefits as needed.
- Work closely with Client Services to resolve claim inquiries and assist in understanding benefit plan set up.
- Participate in peer-to-peer training, including but not limited to assisting with the creation and maintenance of departmental training manuals, standards of operation, and user processing manuals.
- Participate in interdepartmental work groups.
- Maintain electronic records for documentation of all group requests.
- Review quality assurance inquiries and provide resolution or process documentation according to set turnaround time requirements.
- Meet or exceed established goals for accuracy, turnaround time and productivity.
- Work overtime as needed.
- Accesses EPHI following the current guidelines as established at the company
- wide and department levels.
- Maintains regular attendance and punctuality.
- Performs other job-related duties as assigned.

**EXPERIENCE & QUALIFICATIONS**:

- Associates degree in Business Administration, IT or another related field (or equivalent work experience).
- Minimum of 2 years work experience in the dental insurance industry required.
- Strong knowledge of dental policy interpretation.
- Familiarity with dental claims terminology and CDT codes gained through industry experience.
- Knowledge of claim processing and claim policies and procedures.
- Position requires excellent problem-solving abilities and the ability to work independently.
- Must have strong communication skills and the ability to interact positively with both technical team members and business users.
- Detail oriented, accurate and organized with a tendency for research in problem solving.
- Must be able to back up responses to inquiries with documented facts.
- Ability to multi-task.
- Knowledge of business analytics, SQL, programming languages or queries using such tools as Business Objects or Crystal Reports is preferred.