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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Position Title:

Clinical Reviewer (Licensed Dentist)

Reports To:

Director of Utilization Management

FLSA Status:

Non-Exempt, Part-Time

Summary:

The primary function of the Clinical Reviewer is to review dental claim forms, treatment plans and other documents relating to the provision of dental services and impose, wherever applicable, the exclusions and limitations of the Companys dental benefit plans.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.

Review documents submitted by managed care and fee-for-service dentists in the manner set forth in the Companys policies.

Respond on a timely basis to inquiries from staff members regarding the provision of services to enrollees.

If requested, to participate as a member of the Quality Improvement Committee.

If requested, to participate as a member of the Utilization Review Committee.

If requested, to participate as a member of the Complaint and Appeals Review Committee.

Qualifications:

Licensed as a dentist under the laws of the State of New York, authorized to practice dentistry and currently approved by the Department of Education of the State of New York

or;

Licensed as a dentist under the laws of the State of New Jersey, authorized to practice dentistry and currently approved by the Department of Law & Public Safety, Division of Consumer Affairs of the State of New Jersey.

Have no history of any Medicaid/Medicare and/or other governmental regulatory sanctions.

Be properly credentialed by a Credentials Verification Organization.

Maintain a knowledge of current dental procedures, terminology and treatment codes.

Education And/Or Experience:

Be a graduate of an accredited dental school.

Have a minimum of ten (10) years experience in the dental field.

Computer Skills:

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.

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Position Title:

Customer Service Representative

Reports To:

Director of Customer Service

FLSA Status:

Full Time

Summary:

A dental Customer Service Representative receives, investigates and responds to all customer inquiries regarding dental plan coverage, status of claims and provider information.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.

Talk with customers by phone concerning dental plan coverage 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.

Handle irate customers in a professional manner.

Obtain customer feedback 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 and keyboarding skills.

Other Skills:

Knowledge of dental procedures and terminology. Excellent communication skills. Good grammar, voice and diction. Bi-lingual English/Spanish/Russian helpful. Excellent customer service skills (friendly, courteous and helpful).

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