Company :United Concordia Dental
Job Description :
This job provides supervisory direction and oversight for all enrollment, premium billing, claims and/or customer service telephone and written correspondence inquiries (routine, priority Congressional / Department of Defense), and appeals. Ensures that all processes are compliant with requirements and performance standards are consistently met. Responsibilities include: provides supervisor direction, scheduling and support for customer service representatives on both day and overnight work schedules, provides technical support an coaching/mentoring of direct reports, utilizes workforce and inventory management tools/reports to ensure work is evenly distributed for multiple contracts and that adequate resources are allocated to ensure timeliness standards are met for each contract, provides oversight support for the quality control program and initial and ongoing training and mentor programs, and assists to provide interview/hiring and audit support when needed.
- Supervises the daily operations and workforce work distribution to ensure that standards are met for all contracts. Collaborates with other management staff to prioritize and adjust work assignment throughout the day depending on aging and influx of work.
- Interfaces with direct reports daily to provide technical support, coaching, mentoring, reinforcement training and cross-training skill development. Inspires and motivates staff to work to their full potential. Provides routine employee feedback and monthly/annual formal review of performance, achievements, and noting areas where improvement is needed to meet expectations and standards.
- Ensures that dental policy and contract requirements and procedures are current and consistently applied. Provides timely updates to staff. Drafts operation documentation and how-to directives, and instructional memos, as needed, to provide additional clarity.
- Assists to review scheduling of customer service staff to assess the varied work shifts that are needed to handle high call volume periods throughout the day and evening. Updates the workforce management system of staffing changes throughout the day to ensure adequate staff are available during peak call periods.
- Assists to interview and hire new staff. Assists to set-up the mentor program immediately following each class. Employees are cross-trained on multiple contracts and enhanced skill functions; therefore staff development is continually-going.
- Provides oversight direction for the quality control program to ensure that all accuracy standards are met. Ensures that the appropriate sampling is performed, provides employees with routine, timely updates on performance. Provides positive feedback and suggests methods to enhance performance when appropriate. Develops a corrective plan of action, including additional training, if accuracy standards are not met.
- Works to expedite the resolution of employee issues and technical/systems problems. Provides research and technical support need to address complex claims and inquiries and/or when systems problems occur. Provides direction for priority Congressional and Department of Defense inquiries and appeals.
- Performs administration tasks such as leave approvals and functions as a lead/participant in meetings as the department representative. Works on projects and assists with Government and internal audit as needed.
- Other duties as assigned or requested.
- High School Diploma/GED
- No Substitutions
- 1 - 3 years' experience supervising or functioning as a lead/mentor in a fast-paced production environment
- Experienced at problem solving and motivating employees
- Knowledge of dental policy and contract standards, requirement, policies and procedures
- Knowledge of enrollment and billing, claims and/or customer service telephone and written correspondence processes and systems applications
- Experience utilizing workforce and inventory management tools and reports to ensure contract standards are consistently met
LICENSES or CERTIFICATIONS
- Strong understanding and able to apply dental policy and operational policies and procedures, preferably Government business
- Strong interpersonal and personnel management skills
- Knowledgeable in enrollment and billing, claims, and telephone customer service and written correspondence processes and applications
- Strong listening, verbal and communication skills; competent to lead meetings and assist with projects
- Strong problem solving and analytical skills
- Ability to develop and successfully implement effect plans of action to ensure contract standards are consistently met
Please note that this is a claims supervisor position
** Due to Department of Defense (DOD) contract requirements, the incumbent who fills this position must be a US citizen, and must also pass a background check **
Language (Other than English):
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
WFA - Work From Anywhere
100% - Remote
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Referral Level 2:
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org