Additional Information
Location:
HRI Dental Department:
Health Services Weekly Hours:
40 Status:
Full time Shift:
Days (United States of America)
Job Summary:
The Dental Quality Operations Specialist supports the operation, quality, and compliance functions of the dental plan by coordinating activities across multiple teams and ensuring adherence to industry standards and regulatory requirements.
ACCOUNTABILITIES
Grievances, Appeals & Complaints. Acts as the main contact for member and provider grievances, appeals, and complaints-handling intake, acknowledgement, investigation, coordination with internal departments and Health Plan Partner, and issuing timely responses per policies and regulations.
Quality Management Program. Supports the Quality Management (QM) program and facilitates the QM Committee, following the direction of the Dental Plan Operations Manager; responsible for establishing annual initiatives with the committee, coordinating resources, and ensuring key projects and priorities progress throughout the year.
Operations Coordination. Works under the direction of the Dental Plan Operations Manager to address operational needs across departments, including support for enrollment, call center activities, and claims payment processes.
REQUIRED QUALIFICATIONS
Education : Associates in business, management or healthcare administration or related field.
Skills : Strong analytical skills for reviewing data and identifying trends. Able to solve complex problems using sound reasoning. Exceptional writing skills for creating clear reports and professional communication. Understands the importance of professionalism, especially when working with outside companies. Skilled in Microsoft Office programs including Excel, Word, PowerPoint, Access, SharePoint, Salesforce, and Microsoft Project. Able to draft reports and communicate effectively by phone, in writing, and in person. Able to organize and manage multiple tasks independently.
Years of Experience : 1-2 years of experience working in the dental or health insurance industry.
Promedica · Evansville