Company :United Concordia Dental
Job Description :
This job oversees the daily activities, including workforce and inventory management, for Outside the Continental United States (OCONUS) claims/adjustment processing, foreign check stop pay/reissue, telephone customer service and responding to written routine, priority (Congressional/Department of Defense), and appeal inquiries. Responsible for staff direction, coaching, mentoring, and to provide technical assistance. Assists to interview new candidates with foreign language skills, and provides initial and ongoing OCONUS training due to the complex processing and translations required. Position is the point of contact for Government lead personnel in foreign offices, as well as for top OCONUS preferred dentists. Position maintains a strong collaboration with the Government personnel to readily address OCONUS issues and also assists to work with foreign providers to retain and expand the network preferred provider overseas network. Responsibilities also include assisting with translations, verifying foreign exchange payment accuracy and working with the bank to reconcile data and transaction reports. Provides testing support and assists with Government and internal audits.
ESSENTIAL RESPONSIBILITIES (Describes the critical tasks, duties and responsibilities of the position.)
- Supervises staff who perform foreign claims/adjustment processing, foreign check stop pay, reissues, customer service telephone support and written routine, priority (Congressional / Department of Defense), and appeals inquiries, as well as assist to prepare case files for grievance inquiries. Provides workforce and inventory management oversight to ensure all claims and customer service (phone/written) performance standards are consistently met.
- Performs quality control for all OCONUS functions. Provides iniital and ongoing OCONUS training due to the complexity of the processes and the language translations required. Assists to interview and hire staff with foreign language proficiency.
- Develops and maintains OCONUS operational policies and procedures. Functions as the lead for system changes that impact foreign claims processing. Assists with systems testing of OCONUS claims, adjustment, and inquiries, including business disaster recovery testing. Also, provides Government and internal OCONUS audit support.
- Assists with the majority of the foreign claims translations, which are German claims. Is staff does not have the language skills needed, a language translation service is utilized.
- Functions as the point of contact for oversees Government personnel to address unique OCONUS issues and concerns. Also, works collaboratively with the Government to build strong relationships with oversees providers to retain and expand the preferred provider overseas network.
- Verifies the accuracy of Government and internal OCONUS reports. Also, assists to provide bank data and report reconciliation for each check cycle.
- Other duties as assigned or requested.
High School Diploma/GED
Substitutions (Acceptable substitutions in lieu of a degree 1 ½ years’ experience = 1 year college)
Minimum: This section refers to the minimum years and type of applicable experience needed to perform the job. Minimum requirements must be non-comparative, objective, and relevant.
- 1 - 3 years' experience supervising or leading staff in a fast-paced production environment, preferably in dental health care
- Knowledgeable in dental policy with a detailed understanding of Government OCONUS contract requirements, policies and procedures, and reports
- Experience utilizing workforce and inventory management tools and reports to effectively manage daily activity to ensure all contract timeliness and accuracy standards are met
- Knowledgeable in UCCI systems, including claims, adjustments, and telephone and written inquiry systems
- Competent in claims and customer service processes and procedures to effectively perform quality control of all functions
- Experience in providing initial and reinforcement on-going training
- Competent to draft documents, such as training materials, policies and procedures, business specifications, and reports
Preferred: This section refers to additional desired years and type of experience that the hiring manager would prefer, above and beyond the basic requirements of the job.
- Proficient in foreign languages, particularly German
- Experience working collaboratively with Government personnel and other internal support staff
- Experienced working directly with providers and members fluent in a foreign language
- Supervisory and systems testing experience
- Ability to talk to foreign providers about becoming an overseas network provider and/or to attain claims information needed to process initial or adjustment claims
KNOWLEDGE, SKILLS & ABILITIES ( List the attributes required to perform the job through demonstrated service, education or training)
- Excellent personnel management skills; able to effectively hire, train, and coach employees, some of whom are proficient speaking a foreign language and English is their second language
- Workforce and inventory management skills to ensure work is evenly distributed, and monitored to ensure that all contract timeliness requirements are met
- Able to perform quality control review of OCONUS dental claims and customer service functions to ensure that all processes are completed with accuracy, completeness and professionalism
- Knowledgeable in dental policy; able to apply policy to process claims and inquiries, as well as to draft operational policies and procedures
- Professional demeanor; able to collaborate effectively with high level Government personnel
- Excellent listening, verbal and written communication skills
- Attention to detail; competent to verify the completeness and accuracy of Government and internal reporting data prior to report release
** 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 **
REQUIRED LICENSURE (Licenses that are required to perform the job)
TRAVEL REQUIREMENT: 0% - 25%
(List % of time traveling)
LANGUAGE REQUIREMENT ( other than English )?
(List primary language)
PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
( The physical, mental demands and working conditions described here are representative of those that must be met by an employee to successfully perform the essential function of their job. Reasonable accommodations will be made when necessary to enable individuals with disabilities to perform the essential duties of the position, to the extent that they do not cause undue hardship.
WFA - Work From Anywhere
100% - Remote
An employee in this position works in an office environment. The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.
Teaches/Trains others regularly Frequently
Travels regularly from the office to various work sites or from site-to-site Rarely
Works primarily out-of-the office selling products/services (Sales employees)
Does Not Apply
Physical Work Site Required Yes
Most On-The-Road Positions
An employee in this position may work in a home or company office environment but is also frequently driving to and from various locations to perform the work off-site. The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.
An employee in this position is frequently required to move throughout the workplace, sit, stand and walk, use hands and fingers to hold objects, tools or controls, possess fine motor skills (e.g., to write and operate a computer or to steer transportation equipment), possess gross motor skills (e.g., to carry items), reach with hands and arms, climb stairs and ladders, balance, stoop, kneel crouch and crawl, communicate effectively, and talk and hear. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. The employee must be able to work in a busy environment where decisions often must be made quickly, must attend work on a regular and reliable basis, must adhere to all workplace policies, and may be called upon to work outside regular business hours. This work occurs in a [example: warehouse, hospital or provider’s office or mailroom].
Lifting: up to 10 pounds Does Not Apply
Lifting: 10 to 25 pounds Does Not Apply
Lifting: 25 to 50 pounds Does Not Apply
Changes Approved By:
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 position 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
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