Join a recognized leader in the Dental Insurance Industry! Healthplex offers excellent career opportunities in an organization that provides career advancement and training programs while recognizing and rewarding strong performance. Furthermore, we offer a competitive compensation and benefits package and a great work environment.

Current Career Opportunities

Associate Business Process Auditor

Position Title:

Associate Business Process Auditor

Reports To:

Manager, Internal Audit

FLSA Status:

Exempt

Summary:

Internal Audit independently assesses the Company's business processes and procedures and provides assurance that there is compliance with applicable laws and regulations and that the firm's operations are effectively and efficiently controlled. Internal Audit assists in managing Company risk by ensuring documented processes and procedures are adhered to and enhanced where required.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Assist in the development and documentation of department processes and procedures.
Assist in the review of department processes to ensure they are being adhered to.
Make recommendations on revising department processes to enhance efficiency and provide for increased controls and reporting capabilities.
Assist in the development of an audit program, determining which departments are assessed and how often the assessment occurs.
Interview Company personnel to determine if departments are adhering to existing processes and procedures.
Document findings from these interviews and prepare a gap analysis between the documented processes and procedures and actual business practices.
Other duties as assigned.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

Bachelor's Degree (B. A.) and 1-3 years related experience preferred but not required, and/or training or equivalent combination of education and experience.

Computer Skills:

Strong Microsoft Office skills.

Other Skills:

Health industry experience. Strong interpersonal skills and excellent written/oral communication skills. Ability to work as part of a team or as an individual contributor. Project management experience a plus.

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Bilingual Customer Service Representative

Position Title:

Bilingual Customer Service Representative

Reports To:

Director of Customer Service

FLSA Status:

Full Time

Summary:

A Bilingual Customer Service Representative must be able to speak/read/write in English as well as one of the following: Spanish, Russian, Mandarin, or Cantonese. A Bilingual Customer Service Representative assists our members in an inbound call center by investigating and responding to all member inquiries regarding dental plan coverage, status of claims, provider information, and any other information that will assist our members. Customer Service Representatives are full time employees scheduled for 35 hours a week. We are currently looking to fill positions for Monday-Friday from 10:30am to 6:00pm. Paid training will be the first seven business days of employment from 9:00am to 4:30pm.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Efficiently answer inbound calls while resolving member issues concerning their dental coverage
Handle irate customers in a professional manner
Adhere to all attendance/punctuality policies and procedures
Absorb and retain information to ensure consistency when explaining benefits, regulatory items, and policy and procedures
Meet or exceed standards of quality and professionalism as set by both Healthplex and the NCQA
Provide professional and courteous service to all lines of business
Ensure consistency and adherence to departmental work flows, policy and procedures
Follow appropriate avenues of protocol to elevate issues
Input comments regarding customer issue and relative data into the database
Call customers when necessary to advise on next steps and/or inform of resolution
Obtain customer feedback information and multi task while on the phone

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

High School diploma or GED. Preferred Experience: 1 year of Customer Service Call Center experience. Experience working in Dental Office and/or HMO/Insurance

Computer Skills:

Basic computer skills as well as quick and accurate typing skills.

Other Skills:

Fluent (speak/read/write) in English as well as Spanish, Russian, Mandarin, or Cantonese. Excellent communication skills (good grammer, voice, and diction). Excellent customer service skills (friendly, courteous, and helpful).

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Credentialing Assistant

Position Title:

Credentialing Assistant

Reports To:

Director of Credentialing - Healthplex, Inc.

FLSA Status:

Non-Exempt, Non-Union

Summary:

A Credentialing Assistant processes provider information as directed and provides general administrative support to the Credentialing department.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Performs application data entry with strong attention to detail.
Handles follow-up phone calls to providers.
Primary source verification for state licenses, DEA certificates, malpractice insurance and sanctions
Mailing of provider applications.
Filing and scanning of provider information.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

High school diploma or GED

Computer Skills:

Basic computer skills. Familiarity with a keyboard. Excellent verbal communication skills and phone etiquette.

Other Skills:

All qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.

Apply Now

Data Entry Technician

Position Title:

Data Entry Technician

Reports To:

Claims Manager

FLSA Status:

Union; Non-Exempt; Full-Time

Summary:

A Data Entry Technician in the Claims Department is responsible for accurately entering data from claim forms.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Accurately enter high volume of dental claims data into company database.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

High school diploma or GED

Computer Skills:

Strong Data Entry Skills. Minimum data entry speed of 10,000 + keystrokes per hour required.

Other Skills:

Punctual, reliable, strong attention to detail skills required. All qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.

Apply Now

Dental Claims Processor

Position Title:

Dental Claims Processor

Reports To:

Claims Manager

FLSA Status:

Non-Exempt; Full Time

Summary:

A Dental Claims Processor adjudicates dental claims based on summary plan descriptions.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Sort, count and record daily mail into groups and seperate claims that need to be reviewed by dental consultant (x-rays)
Adjudicate claims according to group guidelines. Review member history, eligibility, student status, coordination of benefits, fee schedules, member address, doctor address and other information to verify correctness.
Ensure adjudication of claims within Claims Department time restrictions (and/or alert supervisor/manager before work load falls behind these restrictions)
Review and process electronic claims
Confer with dental consultants regarding high priority cases and/or unclear treatment plans.
Review check runs for accuracy. Make necessary adjustments when errors are found, including tagging checks for voiding.
Enter coordination of benefits information.
Handle claim adjustments taken by Customer Service and placed in daily Claims adjustment folders.
Assist group representatives with questions regarding eligiability, claim issues and plan guidelines when advised by Supervisors.
Research to find correct address when EOB's and checks are returned. When applicable, make corrections and resend.
Return claims to provider/member when essential information has been omitted from the claim form.
Make sure claim numbers and member name/identification numbers are written on all attachments to claim and given to the imaging department on a daily basis.
Fill out refund request forms and type refund request letters regarding overpayments made to members and/or providers.
Act as a back up to another processor (sorting and processing precerts and claims) when the other processor is absent.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

One year certificate from college or technical school; or three to six months related dental assisting and/or insurance billing experience and/or training; or equivalent combination of education and experience.

Computer Skills:

Knowledge of Database software, strong alpha-numeric data entry skills.

Other Skills:

Knowledge of ADA codes, dental procedures and terminology.

Apply Now

Office Assistant

Position Title:

Office Assistant

Reports To:

General Administration Support Supervisor

FLSA Status:

Full Time

Summary:

Staff member in this position is responsible to accurately perform all essential duties.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Opening and Labeling Mail
Bar Coding Claims
Stamping EOBs
Pre-Sorting Claims into straight claims
Recording priority mail and bar code number
Return claims sent to Healthplex in error

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

High school diploma or GED

Computer Skills:

Basic computer skills a plus but not required.

Other Skills:

Apply Now

Outreach Representative (Temporary Assignment)

Position Title:

Outreach Representative (Temporary Assignment)

Reports To:

Supervisor Pediatric Outreach

FLSA Status:

Non-Exempt

Summary:

An Outreach Representative works directly with members and provider offices to increase utilization and access/availability of services to members. An Outreach Representative must be able to speak in English as well as one of the following: Spanish, Mandarin, Cantonese, Russian, Bengali or Urdu. SCHEDULE: Monday - Friday 1:00pm to 5:00pm June 1, 2017 thru December 15, 2017

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Reach out to members by phone and encourage them to utilize their childs coverage
Educate members on their Childs dental benefits and provide members with assistance scheduling a dental appointment with a Healthplex dental office
Track and document member Appointments
Call members to confirm dental appointments

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

High school diploma or GED with (1-2) years of Customer Service Call Center experience preferred. Excellent verbal and written communication skills.

Computer Skills:

Basic computer and keyboarding skills.

Other Skills:

Apply Now

Provider Relations Associate

Position Title:

Provider Relations Associate

Reports To:

Provider Relations Manager, Healthplex, Inc.

FLSA Status:

Non-Exempt

Summary:

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Respond to provider information requests
Send Welcome Letters and other communications in a timely manner
Research provider information in the Oracle database, Cactus, and Highview
Process mail and faxes according to set schedule
Track submitted provider updates
Perform research and information updates for site visit issues
Input site visit data into Oracle
Handle and/or direct provider calls appropriately - both incoming and outgoing
Manage and prepare materials for department daily needs and events, e.g., fee schedules, Provider Manual, etc.
Assist Provider Relations staff and management with tasks such as setting up meetings, taking meeting Minutes, data entry, and requesting Mailroom stock
Other duties as assigned

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

Associates or Bachelor's degree from 2-year or four-year college or university and one to three years related experience and/or training; or equivalent combination of education and experience.

Computer Skills:

Microsoft Outlook, Basic Excel, Word, Access, and Oracle or comparable software experience.

Other Skills:

Strong communication skills, including writing and grammar. Background in Healthcare helpful. All qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.

Apply Now