Customer Service Government Programs Training and Support Specialist

Delta Dental of Michigan is one of the largest dental plan administrators in the country, dedicated to improving oral health through benefit plans and community support. The Customer Service Government Programs Training and Support Specialist will provide day-to-day support to customers, resolve claims and inquiries, and develop training programs for employees.

Responsibilities:

• Serves as primary CSR support to assist with detailed interpretation of dental policies, procedure codes, claims processing, Medicare Advantage/Medicaid compliance guidelines and policies and procedures. Researches, analyzes, adjudicates and makes appropriate determinations on difficult claims and inquiries
• Develops, coordinates and conducts new-hire onboarding and training, as well as periodic refresher and training on new functionality and processes. Researches and implements training programs using various methods of instruction
• Identifies, creates and maintains government programs training and support specialist processes and procedures
• Prescreens claims and inquiries for the Professional Review and Focused Review departments
• Communicates with other departments to identify and troubleshoot potential processing and/or system issues
• Collaborates with department management, quality assurance specialists and reporting specialists to identify process improvements, department trends and training needs
• Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above

Requirements:

• Position requires one year of college, technical, vocational or business school with coursework in dental assisting or dental hygiene, business administration and composition
• Two years of related work experience
• Intermediate knowledge of word processing and spreadsheets
• Knowledge of dental terminology, procedures, insurance products, and claims processing
• Knowledge of procedure writing and training content development
• Ability to analyze and resolve complex problems
• Ability to identify, research and resolve customer complaints/issues
• Ability to handle multiple projects and deadlines and multitask
• Excellent verbal and written communication and organization skills
• Ability to work independently and make informed decisions quickly
• Ability to work flexible hours including some weekends
• Previous Medicare and/or Medicaid experience