Overall Responsibility: To deliver high quality client service to doctors or doctor's office staff, members, community partners and plan sponsor representatives in a professional, respective and helpful manner. Process claims in a timely, accurate manner.
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;