Digital and Outbound Rep

Location: Milwaukee, Wisconsin, United States

Notice

This position is no longer open.

Remote Opportunity: 0

Requisition Number: 3757

Position Title: Digital Services Representative I

External Description:

JOB SUMMARY:

The Digital Service Representative performs OCR and manual entry and updates within various critical components necessary for the Claims and Utilization Management teams as well as Complaints, Grievances & Appeals.   This position handles entry and update for both S&H and G&I plans as well.

 

PRIMARY JOB RESPONSIBILITIES:

  • Maintain on-going knowledge of the functionality of the claims processing system to assure the most updated processes are followed and the most appropriate data is applied in completion of each task.
  • Each team member must maintain a complete and robust knowledge of each business unit  ( Delta and Commercial as well as State and Health plan)  to appropriately and accurately complete the daily tasks within the required client specifications and turn time as well as  meet or exceed the department metrics for speed and accuracy.
  • The specific daily tasks include but are not limited to:
    •  Manual entry of claims to expedite adjudication for member care as well as claim payment at a 99% accuracy rate.
    •  Research and correction of membership data of existing claims to avoid delay in adjudication at a 99% accuracy rate.
    •  Research & entry of Complaint, Grievance & Appeals case files from 5 sources requiring the team member to access each source and recognize the required components to enter into the C&G module within the processing system at a 98% accuracy rate.
    • Correction processing of claims rejected from OCR vendor which requires review to determine the reject reason and how to rectify the claim for adjudication at a 99% accuracy rate.
  • Additional tasks assigned to this team:
    • Daily audit of inbound correspondence to assure an unbiased review of input is recorded.
    • Daily manual creation of letters to Providers for specific return reasons which requires specific attention to detail to avoid any cross-branding violations.
    • Daily reconciliation of OCR paper claim volumes.
    • Fulfillment of client audit requests is an additional responsibility for this team which includes:
      • Printing of all claim documents and checks based on the client claim selection for the audit.
      • Assembly of documents into a concise format to deliver electronically or in paper format to client.

 

  • Thorough understanding of the workflow and the processing system is also required to accurately and adequately report and follow-up on system issues or request enhancements via the ServiceNow software.
  • Ensure Protect Health Information (PHI) is secure when handling and processing documents.
  • Maintain safe and clean working environment by complying with procedures, rules, and regulations.
  • Provide recommendations for process improvements within the department and/or enterprise
  • Other duties as needed or required.

 

JOB QUALIFICATIONS:

Required:

  • High School diploma or equivalent
  • 2 years office work experience
  • Previous experience in data entry.
  • Strong organization and attention to detail.
  • Ability to prioritize multiple job duties.
  • Ability to work independently and with a team. 
  • Ability to learn quickly and adapt to a fast pace production environment.
  • Ability to efficiently operate all job related office equipment which may include a PC, paper scanner or digitizer.
  • Demonstrated effective written and verbal communication skills
  • Required to attend additional training as requested/deemed necessary

Preferred:

  • Bachelor Degree Preferred.

 

PHYSICAL DEMANDS:

    • Incumbent must be able to communicate effectively.  
    • Requires overall light physical effort (up to 25lbs.)
    • Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal computer).
    • Ability to travel or move about within and outside serviced facilities required           
  • Incumbent works primarily in either a private or shared office environment

The specific statements shown in each section of this description are not intended to be all-inclusive.  They represent typical elements and criteria necessary to successfully perform this position.

 

 

City: Milwaukee

State: Wisconsin

Community / Marketing Title: Digital and Outbound Rep

Company Profile:

We believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.

Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it. 

To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.

The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.

Company Profile Job:

At DentaQuest, we believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.

Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it. 

To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.

The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.

Location_formattedLocationLong: Milwaukee, Wisconsin US

CountryEEOText_Description: In accordance with our Compliance Plan, employees must conduct business in accordance with applicable laws, regulations, professional standards and ethical standards and report potential compliance or ethical issues to manager or Compliance Officer. Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please see Human Resources for additional information regarding this Program. Equal Employment Opportunity Statement: We are committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, or sexual orientation.

Need Assistance?

Can't find a job that fits what you are looking for? Submit your resume and allow one of our Talent Advisors help you in your next career move.

Update Your Resume

If you already have a resume on file with us click here to update your profile.