High School Diploma or GED required.
1 year of C&G experience with demonstrated success in C&G Specialist 1 or higher-level roles such as Lead or Supervisor role.
Typing skills of 40+ words per minute.
Excellent customer service skills.
Good PC Skills.
Excellent verbal and written communication skills.
PC experience with knowledge of Windows and the ability to work with other software applications is required.
Effective oral communication and business writing skills are required.
Attention to detail, accuracy and organizational skills are essential.
Effective interpersonal and organizational skills are essential.
Ability to prioritize and adapt to changing priorities is essential.
Resolve / investigate complaints in accordance with Plan guidelines.
Contact involved provider office to obtain information to properly review the case.
Document provider’s/staff’s perception of the member’s concerns / issues.
A follow-up letter is submitted to the Plan with the resolution/findings.
Assure health plans receive requested information as needed.
Establish and maintain professional relationships with Plan contacts.
Track complaints, grievances, and appeals in department tracking system
Adherence to department guidelines and timeframes.
Communicate ways to improve processes and procedures to management.
Identify areas for improvement or processes that are unproductive, time consuming, and/or inefficient and communicate that information to management.
Interacts in a cooperative, professional and effective manner with co-workers and DentaQuest staff.
Interacts in a cooperative, professional and effective manner with visitors, providers, and Plan representatives.
Ability to prioritize and organize multiple tasks.
Ability to remain organized with multiple interruptions.
Ability to work overtime as needed or required to meet business objectives.
Required to attend additional training as requested/deemed necessary.
Experience working in a managed care environment is desired.
College degree is desired.
Bachelor’s Degree in Communications, Social work, Health care, or Psychology preferred.
Incumbent must be able to communicate effectively.
Requires overall light physical effort (up to 25lbs.)
Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal computer).
Ability to travel or move about within and outside serviced facilities required.
Incumbent works primarily in either a private or shared office environment.