Provider Relations QA Specialist

For more than 45 years, Careington International has been a leader in the health and wellness benefits space. Since its founding in 1979, Careington has been delivering dental discount solutions as its core competency. Today, Careington has expanded to offer a growing portfolio of 150+ health, wellness, lifestyle and virtual health products and services designed to deliver cost savings across a spectrum of life needs. Through its affiliated nationally licensed third-party administrator (TPA), Careington also delivers full-scale administrative services, including customer service, licensed enrollment, claims administration, individual and group billing, and more.

We are based in Frisco, TX. If you are looking for a great company culture filled with rewarding career advancement opportunities, this is the place for you. 

Key Responsibilities: 

• Serve as a dedicated liaison for clients and provider offices, ensuring consistent communication and support.

• Answer incoming calls from provider offices in a timely and professional manner while delivering excellent customer service.

• Operating in a deadline driven environment requiring timely resolution of provider and client inquiries.

• Manage and respond to a large-scale of email inquiries from provider offices and clients, along with providing accurate information and timely follow-ups.

• Educate dental offices on plan administration, policies, and participation requirements via phone and email.

• Contact dental offices to research and gather information regarding member billing concerns and quality-of-care grievances.

• Conduct audits of dental offices to ensure compliance with participation requirements and plan administration guidelines.

• Maintain detailed and accurate documentation of all communications and case activity within internal systems.

• Balance a large volume of tasks, ensuring consistent tracking and follow-up with provider offices, internal teams, and clients.

• Maintain a high level of professionalism, organization, and customer service in all interactions.

Skills & Competencies: 

• Demonstrate advanced problem-solving and analytical thinking skills with the ability to make independent decisions.

• Maintain a high level of professionalism, organization, and customer service in all interactions.

• Possess excellent conflict resolution and de-escalation skills.

• Exhibit efficient time management and multitasking in a fast-paced environment

• Communicate effectively through both written and verbal communication.

• Apply professional phone etiquette and active listening skills with empathy.

• Retain and apply policies and procedures to address provider and member inquiries.

• Ability to handle sensitive information with discretion and professionalism.

Qualifications: 

• Experience within a call center software queue environment is highly preferred.

• Background in dental or medical administrative work is considered a plus for this role.

• Maintain proficiency in Microsoft Office Suite (Word, Excel, Outlook, Adobe, Microsoft Teams).

• A college degree is preferred, but equivalent work experience will be considered.