Job Description

Job Description

Job Description

Job Title: Customer Service Agent Regular Full-Time

Reports to: Supervisor, Customer Service

Work Location: Hybrid, Parsippany, NJ, US

Salary Range : $24.29

About Us :
Delta Dental of New Jersey, established in 1969 as the state's largest dental coverage provider, has grown over more than 50 years to serve over 1.7 million people across New Jersey and Connecticut. As part of the national Delta Dental Plans Association, we connect over 75 million people with quality dental coverage through 139,000 groups nationwide.

In Connecticut we operate through Delta Dental of Connecticut, Inc., which writes fully insured dental coverage. In New Jersey, Delta Dental of New Jersey, Inc. writes fully insured and self-funded dental benefit programs. Our comprehensive offerings include managed care, approved fee for service, PPO, and HMO-type programs, as well as dental access and individual dental plans. We also offer DeltaVision® in conjunction with VSP®, serving more than 88 million members through nearly 137,000 access points nationwide.

With a team of 300 dedicated employees, we remain committed to innovation and excellence in dental insurance, as reflected in our Standard & Poor's "A+" rating for financial strength. Our commitment extends beyond business through the Delta Dental of New Jersey Foundation, which awards nearly $1 million annually to support dental care for underserved populations, educational scholarships, and community programs.

Our Mission Statement is to promote oral health to the greatest number of people by providing accessible dental benefit programs of the highest quality, service, and value. Join our growing team and be part of an organization that values associate development, promotes wellness initiatives, supports diversity, and provides opportunities to volunteer for causes you care about.

Benefits :

In addition to a great culture, we offer excellent benefits including medical, RX, dental and vision, matching 401k, tuition reimbursement, and generous time off to recharge. We value our associates and support everyone with learning and development, active wellness and diversity initiatives, and even paid time off to volunteer at causes that you care about. ** see below for additional benefit information.

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

Adaptability/Flexibility

Communication

Computer Skills

Customer Focus

Dependability

Job Knowledge

Productivity

Quality

Teamwork

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
• 1-3 years' experience in a dental office/practice
• Dental Assistant education/experience is a plus

Required Educational Level

• Requires high school diploma or equivalent.

Other Certification

• n/a

*Salary Disclaimer: The rate of pay for this position is set by the applicable collective bargaining agreement for this bargaining unit and is subject to change based on future negotiations.

**Benefit Disclaimer:

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 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.

Delta Dental of New Jersey invites all qualified interested applicants to apply for career opportunities. If you are a person with a disability and need reasonable accommodation, please contact hr@deltadentalnj.com.

Job Tags

Full time,

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