Dental Network Provider Relations Specialist
- Act as liaison between providers, members, and act as the dedicated liaison for assigned clients
- Answer phone calls from providers and handle inquiries in real time
- Resolve provider calls effectively and efficiently, with the intent for one-call-resolutions when possible
- Contact provider offices to resolve member billing and quality of care grievances
- Negotiate refunds from provider offices on behalf of the member if overbilling has occurred
- Professionally write resolution letters due to member billing or quality of care inquiries
- Educate provider offices on plan administration, plan participation, and other facets of Careington’s network by phone
- Work with marketing and team to create education materials and distribute them to the network
- Audit offices for participation and plan administration
- Work with compliance on addressing escalated issues
- Willing to perform all other responsibilities as assigned and assist in other department projects as needed
- Maintain a thorough working knowledge of Careington’s Network Development department and functions
- Must be a self-motivator with a high desire to add value to the day to day operations of the department
- Possess high level problem solving and analytical thinking skills that will assist in making independent judgment decisions to provider/member inquiries
- Strong conflict resolution skills to de-escalate
- Have a strong sense of time management and organizational skills with the ability to effectively manage various daily tasks
- Must be able to retain and apply learned information to all request presented
- A strong knowledge of basic mathematical calculations is required
- Impeccable communication skills – both written and verbal
- Must have professional phone demeanor and superb listening skills for callers
- Proficient within MS Office Suite products: Word, Adobe, Excel, Outlook
- Phone experience; engaging with inbound callers
- Dental or medical insurance industry knowledge is a plus
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