Claims and Customer Service Quality Assurance Coordinator

Job Description

Job Description

Job Title: Claims and Customer Service Quality Assurance Coordinator Regular Full-Time

Reports to: Manager, Shared Services Operations

Work Location: Hybrid, Parsippany, NJ

Salary Range: $55,000 - $60,000

About Us:

Delta Dental of New Jersey, established in 1969 as the state's largest dental coverage provider, has grown over more than 50 years to serve over 1.7 million people across New Jersey and Connecticut. As part of the national Delta Dental Plans Association, we connect over 75 million people with quality dental coverage through 139,000 groups nationwide.

In Connecticut we operate through Delta Dental of Connecticut, Inc., which writes fully insured dental coverage. In New Jersey, Delta Dental of New Jersey, Inc. writes fully insured and self-funded dental benefit programs. Our comprehensive offerings include managed care, approved fee for service, PPO, and HMO-type programs, as well as dental access and individual dental plans. We also offer DeltaVision® in conjunction with VSP®, serving more than 88 million members through nearly 137,000 access points nationwide.

With a team of 300 dedicated employees, we remain committed to innovation and excellence in dental insurance, as reflected in our Standard & Poor's "A+" rating for financial strength. Our commitment extends beyond business through the Delta Dental of New Jersey Foundation, which awards nearly $1 million annually to support dental care for underserved populations, educational scholarships, and community programs.

Our Mission Statement is to promote oral health to the greatest number of people by providing accessible dental benefit programs of the highest quality, service, and value. Join our growing team and be part of an organization that values associate development, promotes wellness initiatives, supports diversity, and provides opportunities to volunteer for causes you care about.

Benefits:

In addition to a great culture, we offer excellent benefits including medical, RX, dental and vision, life insurance, short- and long-term disability, spending accounts, and matching 401k. We value our associates and support everyone with learning and development, recognition programs, active wellness and diversity initiatives, tuition reimbursement, and generous paid time off to recharge – even paid time off to volunteer at causes that you care about. * see below for additional benefit information.

Job Summary

The Claims and Customer Service Quality Assurance Coordinator is responsible for providing ongoing administration of Delta Dental’s Quality Assurance Program by performing accurate, consistent, fair, and objective evaluations of business unit performance and continually works to identify patterns, common errors and system issues to assist the processing department in reducing risk and improving effectiveness.

The Claims and Customer Service Quality Assurance Coordinator acts in a supporting role to staff, consistently providing motivational feedback to improve the attributes that enable the business units to exceed customer expectations.

To ensure that Delta Dental company standards are maintained, and integrity is preserved, the areas of review will include but are not limited to Customer Service, Claims, Enrollment/Billing, Appeals and Grievances, Configuration, Group Contracts/ Benefit Booklets, and anywhere else deemed necessary across the organization.

The Claims and Customer Service Quality Assurance Coordinator regularly consults with management to review and resolve quality discrepancies and provides monthly and on-going results to the team members. The OQA Coordinator will review standards, policies, and procedures, as well as make recommendations to update and evaluate the effectiveness of processes and procedures.

The Claims and Customer Service Quality Assurance Coordinator supports the training department as needed. This may include knowledge transfer through facilitating training classes, providing 1:1 sessions following training classes, train the trainer and providing individual coaching sessions for management and hourly associates to drive quality and develop our associates.

This role is not a IT Data Analyst or IT Quality Data Analyst.

Essential Functions & Responsibilities

• Compiles necessary data to begin review and analysis. Consults with management and other staff to clarify questionable information.
• Analyzes data using written procedures, practices and guidelines as a standard for determining discrepancies.
• Prepares written reports regarding review/analysis which may include recommendations to senior management.
• Creates and maintains supporting documentation and files as necessary.
• Meets with various department heads regarding standards and practices.
• Reviews work for financial, clerical, system and other errors.
• Measures and evaluates the performance of the customer service agents who come in direct contact with Delta Dental’s customer base and ensures objectives are being met so that the company maintains operations at an optimal level.
• Performs other related research and analysis as determined by the department head.

Essential Qualifications

To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required.

• Must possess a high level of competence in claims processing systems including Electronic Claims Submission, Customer Service, Enrollment, and anywhere else deemed necessary across Operations.
• Prior Insurance experience required, health is required, dental knowledge a plus.
• Ability to work in a Windows environment, proficiency in word processing and Excel spread sheets applications. Prior experience working with and creating formulas, highly desired.
• Ability to analyze data, draw conclusions, be innovative and detail oriented with demonstrated attention to detail and accuracy and demonstrated math proficiency.
• Must possess excellent oral and written skills.

APPROVALS

Management retains the discretion to add or change job duties at any time.

DDNJ Competencies (include those that are most necessary for success of position)

Accountability

Adaptability-Flexibility

Communication

Job Knowledge

Listening Skills

Planning

Problem Solving-Analysis

Critical Thinking

Collaborative Process-Teamwork

Initiative

Knowledge, Skills & Abilities

• Ability to meet deadlines and attendance standards.

Technical and Functional

Required Physical Abilities

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to sit and perform extensive close keyboard and PC work
• Ability to walk, talk or hear
• Occasionally required to stand and reach with hands and arms

This position is required to:

• Sit six (6) hours per day five (5) days per week to perform job functions.
• May occasionally be required to lift cartons of claim forms weighing up to 20 lbs.

Working Environment

• The noise level in the work environment is usually moderate.
• This classification will be required to sign a confidentiality agreement.

Required Educational Level

• A bachelor’s degree or associate’s degree
• Minimum of 4 years’ experience with Health Insurance; ideally in a similar role but may come out of the claims and/or customer service areas.
• Minimum of 2 years’ experience with Dental Insurance.

Certifications required/preferred

* Benefit Disclaimer:

The benefits set forth in this posting reflect DDNJ’s benefits policies in place at the time of posting, as are made available to other similarly situated employees of DDNJ, although participation is at all times in accordance with and subject to the eligibility and other provisions of such plans and programs. DDNJ reserves the right, in its sole discretion, to prospectively modify or terminate any of its benefits plans or programs at any time and for any reason, to the extent permitted by applicable law. DDNJ complies with all applicable state and federal wage and hour, pay equity and pay transparency laws.

Primary Location Full Time Salary Range:

In addition to salary, Delta Denta of New Jersey’s offerings may also include, for eligible employees, discretionary and formulaic incentive awards. Available offerings may vary by geographic location, job level, skills, experience, qualifications, education and date of hire.

Delta Dental of New Jersey is an equal opportunity employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, ancestry, sex, sexual orientation, gender identity, national origin, genetics, disability, marital status, age, veteran status, domestic partner status, medical condition or any other characteristic protected by law.

Delta Dental of New Jersey invites all qualified interested applicants to apply for career opportunities. If you are a person with a disability and need reasonable accommodation, please contact: hr@deltadentalnj.com