Operations Analyst Delta Dental of Rhode Island - 3.5 Providence, RI Job Details Full-time 7 hours ago Qualifications Customer communication Research High school diploma or GED Full Job Description

POSITION SUMMARY

This position is an integral part of the Operational team. In this role, the analyst will assist in various Operational processes including; new client setup, management of client, system configuration, claims resolution, and quality control of client related transactions. This individual will be a key resource to answer inquiries from other areas throughout the company.

Essential Functions:

Client Setup Record system transactions to account for any changes in a client's general and/or benefit information. Quality control checks of all system transactions. Serves as a resource to the organization regarding processing of client related information and transactions. Maintain and process client renewal transactions. System Configuration Research and configure system rules based off client benefit modifications, CDT updates and companywide policy changes. Propose new innovative rules to Management that enhance the claim processing system that will help build efficiencies and increase accuracy. Claims Resolution Plans, allocates, and monitors workflow to assure the accurate and timely completion of assignments within established production and inventory standards. Assists in the oversight of the processing and adjudication of claims by guiding the activities of the claims analysts; monitors and communicates corporate policies and procedures to assure a high level of accuracy and completeness within established production and inventory standards. Researches any unusual payments and refunds; processes the most complex type of claims which involve judgment and interpretation based on precedent, knowledge of the dental terminology, and a thorough understanding of the Corporation's claims processing policies and procedures. Research and resolve potential client overpayments and underpayments. Performs the overpayment recovery process to recoup overpayments made to the dentists. Interact regularly with Customer Service to answer claim-related questions. Data Analysis and Reporting Becomes knowledgeable with analytical tools and collaborates/recommends new operational reports to Data Analytics team. Quality Control Responsible for the quality of various operations department tasks including rule updates, coordination of benefit processing, ortho claims, internally entered claims pretreatments and client data management. Testing Assists in the evaluation of all system releases to ensure accuracy and completion. Participates in pre-release testing with Project Management Other Duties Participates in special projects as required by management. Performs other duties as assigned.

Requirements:

High School Diploma or equivalent; Associates or Bachelor's degree preferred. Excellent communication and organizational skills. Attention to detail and accuracy. Prior knowledge of database programs preferred. Entry Level Training Received (If any) Extensive training in claim, eligibility, and provider functions as well as workstation training. Work Environment /

Physical Demands:

Typical office environment

Attendance Requirements:

40-hour workweek (M-F) as assigned and additional hours as required