Insurance Associate

Position Summary

Eligible associate will perform dual role of processing dental claims basis the response received from the customer and handle customer service inquiries via the telephone and/or email and answer questions or resolve problems.

Backend Profile - All the claims which cannot be processed by the sub-contractor, comes in Metcor queue. Work queues that have claims route to GOSC can be defined by the type of edit that requires resolution (eligibility, plan, provider or code related). Claims are researched and reviewed for approval, non-payment, referral or request for additional information

Voice Profile - Use computerized systems for tracking, information gathering, and/or troubleshooting.  Maintain quality service by following policies and procedures and reporting needed changes. And, contribute to team effort by accomplishing related results as needed

Job Responsibilities

Backend Profile

• Scrutinizing dental claim documents & settlements
• Process claims as per the set healthcare guidelines
• Follow HIPPA guidelines
• Accurate processing of Dental claims
• Good understanding of ICT & CPT Codes
• Knowledge of policy concepts like Deductible, coinsurance, copay, out of pocket
• Able to learn, adapt, implement process guideline into practice, work as a natural team-player in the   
• Process
• Handle escalations
• Need to ensure quality and productivity targets are met
• Ensure compliance with internal policies and procedures, external regulations and information security standards

Voice Profile

• Will handle customer service inquiries via the telephone and/or email and answer questions or resolve problems from Dental offices
• Use computerized systems for tracking, information gathering, and/or troubleshooting
• Maintain quality service by following policies and procedures and reporting needed changes, and contribute to team effort by accomplishing related results as needed
• The successful candidate will leverage effective listening skills, an attention to detail, strong intellectual curiosity and an honest desire to make a difference to ensure each customer experience is exceptional
• With an understanding of the customers’ needs and wants, and a focus on delivering solutions that meet those needs, you will deliver a service experience that exceeds expectations and makes it easy for customers to do business with us
• Scrutinizing dental claim documents & settlements