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Telephone Inquiry Specialist - 1672

Wollborg Michelson Recruiting

Rancho Cordova, CA

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JOB DETAILS
SKILLS
Adjudication, Anatomy, Billing, CIFS (Common Internet File System), Call Monitoring, Claims Processing, Communication Skills, Compensation and Benefits, Computer Skills, Customer Support/Service, Detail Oriented, Diversity Recruiting, Documentation, Legal, Mail Processing, Mathematics, Medical Treatment, Multitasking, Pathology, Patient History, Physiology, Presentation/Verbal Skills, Problem Solving Skills, Radiography, Regulations, Telephone Skills, Time Management, Time Tracking, Writing Skills
LOCATION
Rancho Cordova, CA
POSTED
30+ days ago

Dental Program Customer Service Specialist


Job Summary

Handles complex inquiries and documentation related to a dental benefits program, providing information and support to beneficiaries and dental providers while ensuring accurate tracking and resolution of issues.

Responsibilities
  • Research, resolve, and respond to complex telephone inquiries escalated from front-line representatives.
  • Monitor cycle time reports to ensure timely response and resolution of issues.
  • Process in-house documents such as CIFs, NOAs, Claims, TARs, and RTDs.
  • Respond to incoming calls from dental program beneficiaries and their representatives regarding general program policies, screening appointments, TAR notifications, and complaints.
  • Refer callers to appropriate dental providers, reschedule screening appointments, and direct callers to other agencies or resources as needed.
  • Track beneficiary call information in the Beneficiary Correspondence Tracking System.
  • Respond to incoming calls from dental provider offices regarding program policies and procedures, claims and TAR processing, EOB and payment inquiries, patient history, and office enrollment status.
  • Track provider call information in the Provider Correspondence Tracking System.
  • Participate in miscellaneous projects and assignments as needed.

Requirements
  • Dental Assisting Certificate from an accredited dental assisting school and/or a minimum of two years of dental assisting experience in a dental office.
  • Successful completion of relevant dental audit and x-ray reading assessments, if required.
  • Minimum of one year of communication or customer contact experience.
  • Ability to work regular overtime as required.
  • Knowledge of dental provider billing procedures and claims adjudication processes.
  • Familiarity with applicable program rules and regulations, dental codes, procedures, and practices preferred.
  • Ability to handle detailed work with accuracy and maintain confidentiality.
  • Ability to manage multiple concurrent tasks and handle constant interruptions.
  • Effective stress management and reasoning skills.

Skills
  • Strong verbal and written communication skills.
  • Problem-solving and basic math skills.
  • Proficiency with computer tools and call tracking systems.
  • Knowledge of dental anatomy, physiology, pathology, and dental nomenclature.
  • Customer service and customer contact skills.
  • Ability to work efficiently in a fast-paced, high-interruption environment.

Summary Qualification
  • Certified or experienced dental assistant with solid understanding of dental practices and terminology.
  • Experienced in handling complex inquiries from both beneficiaries and providers.
  • Demonstrated ability to process and track claims, authorizations, and related documentation accurately.
  • Proven ability to manage multiple tasks while maintaining attention to detail and confidentiality.
  • Skilled in using computer-based tracking systems and tools to document and resolve calls.


Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status.

About the Company

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Wollborg Michelson Recruiting