Customer Service Associate

Job Summary

A Customer Service Agent following established company guidelines resolves customer issues received by telephone, mail or fax from group administrators, subscribers and dentists.  An Agent explains Delta Dental 's group contracts, agreements, processing policies and procedures.  An Agent can also adjudicate dental claims and resolve adjustments. 

 Essential Functions & Responsibilities 

•  Adhering to the Agent’s schedule, the Agent is required to be available on the call center ACD to answer customer calls while meeting and exceeding department KPI’s.
• As a team member, researches and resolves inquiries and responds to customers with an appropriate and accurate written or verbal notification.
• Calculates adjustments and creates and processes claims for adjusted payments.
• Creates and processes standard claims, claims with coordination of benefits, pre-treatment estimates, and pretreatment estimates with dated services.
• Maintains and updates subscriber files with information obtained through inquiries and submitted claims and documents, i.e., individual and family on hold codes, applied or removed.
• Performs all tasks necessary to resolve all questions based on Delta Dental’s claims processing guidelines and Dentist handbook, as well as Delta Dental’s website and mobile application.
• Documents each inbound call in call tracking, follow up, or any pended requests.
• Generates check research requests for outstanding payments.
• Understands all claim guidelines and effectively uses this information to resolve related inquiries.
• Researches and resolves requests from other departments such as Marketing and Enrollment.
• When necessary, refers claims or subscriber eligibility to Management or other departments such as Professional Services, Claims, Marketing and Enrollment.
• Supports and participates as needed for inventory reduction tasks such as correspondence and/or call tracking.
• Other duties as assigned  

Essential Qualifications 

 Competencies 

 Knowledge, Skills & Abilities 

 KPI’s 

• Adherence standard is 96% 

• After call work time – 10 seconds 

• Quality:  99% 

 Technical and Functional  

• Ability to regard customer service excellence as a priority 

• Personal computer skills with knowledge of MS applications such as Windows, Word and Excel and browser based applications such as Internet Explorer 

• Excellent communication and listening skills 

• Excellent math aptitude 

• Creativity and flexibility when solving problems 

• Ability to work in an environment where work is carefully monitored for accuracy 

 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 including data entry  

• Ability to walk, talk or hear 

• Occasionally required to stand and reach with hands and arms 

 Working Environment 

• Ability to meet attendance standards.  

• Must be able to sit/stand, talk and hear. 

• The noise level in the work environment is usually moderate. 

• This classification will be required to sign a confidentiality agreement. 

 Experience, Education and Certifications Required  

 Experience Required 

 1-3 years customer service/call center experience 

• Dental Assistant education/experience is a plus 

 Required Educational Level  

•  Requires high school diploma or equivalent. 

Other Certification 

• n/a 

About Delta Dental Of New Jersey & Connecticut
Delta Dental of New Jersey, Inc. is New Jersey's leading dental benefits company, providing or administering coverage to more than 2.2 million people through contracts with groups and individuals in New Jersey and Connecticut. In Connecticut, Delta Dental of Connecticut, Inc. is a licensed insurer that writes dental and vision coverage on an insured basis, and Delta Dental of New Jersey administers self-funded dental benefit programs.

Offering dental benefits since 1969, Delta Dental of New Jersey's mission is to promote oral health to the greatest number of people by providing accessible dental benefit programs of the highest quality, service, and value. Through its philanthropic arm, the Delta Dental of New Jersey Foundation awards more than $1M in grants annually to support access to dental care and education for underserved children, seniors, veterans, and those with special needs, as well as funds workforce development programs for dental assisting and dental hygiene across New Jersey and Connecticut.

Benefits
In addition to a great culture, we offer excellent benefits including medical, dental, 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.

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.

Delta Dental of New Jersey Inc 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.