Job Description

Customer Service Government Programs Training And Support Specialist

At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.

At Delta Dental, we celebrate our All In culture. It's a mindset, feeling and attitude we wrap around all that we do from taking charge of our careers, to helping colleagues and lending a hand in the community.

To provide day-to-day support to internal and external customers by resolving difficult claims, inquiries, grievances and appeals to ensure accurate benefits administration and delegation. Analyzes contacts to ensure accuracy, which includes, but not limited to, listening to calls, reviewing call logs, working one-on-one with customer service staff and/or other internal departments. Develops and conducts Government Programs department employee training on department systems and processes and the application of corporate policies, procedures, and guidelines.

Primary Job Responsibilities:

• Serves as primary CSR support to assist with detailed interpretation of dental policies, procedure codes, claims processing, Medicare Advantage/Medicaid compliance guidelines and policies and procedures. Researches, analyzes, adjudicates and makes appropriate determinations on difficult claims and inquiries.
• Develops, coordinates and conducts new-hire onboarding and training, as well as periodic refresher and training on new functionality and processes. Researches and implements training programs using various methods of instruction.
• Identifies, creates and maintains government programs training and support specialist processes and procedures.
• Prescreens claims and inquiries for the Professional Review and Focused Review departments.
• Communicates with other departments to identify and troubleshoot potential processing and/or system issues.
• Collaborates with department management, quality assurance specialists and reporting specialists to identify process improvements, department trends and training needs.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

Minimum Requirements:

Position requires one year of college, technical, vocational or business school with coursework in dental assisting or dental hygiene, business administration and composition and two years of related work experience. Previous Medicare and/or Medicaid experience is preferred. Will accept any suitable combination of education, training, or experience. Position requires intermediate knowledge of word processing and spreadsheets; knowledge of dental terminology, procedures, insurance products, and claims processing; knowledge of procedure writing and training content development; ability to analyze and resolve complex problems; ability to identify, research and resolve customer complaints/issues; ability to handle multiple projects and deadlines and multitask; excellent verbal and written communication and organization skills; ability to work independently and make informed decisions quickly; and ability to work flexible hours including some weekends. The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.

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