Dental Quality Operations Specialist

Location:

HRI Dental

Department:

Health Services

Weekly Hours:

40

Status:

Full time

Shift:

Days (United States of America)

Job Summary:

The Dental Quality Operations Specialist supports the operation, quality, and compliance functions of the dental plan by coordinating activities across multiple teams and ensuring adherence to industry standards and regulatory requirements.

ACCOUNTABILITIES

• Grievances, Appeals & Complaints. Acts as the main contact for member and provider grievances, appeals, and complaints-handling intake, acknowledgement, investigation, coordination with internal departments and Health Plan Partner, and issuing timely responses per policies and regulations.
• Quality Management Program. Supports the Quality Management (QM) program and facilitates the QM Committee, following the direction of the Dental Plan Operations Manager; responsible for establishing annual initiatives with the committee, coordinating resources, and ensuring key projects and priorities progress throughout the year.
• Operations Coordination. Works under the direction of the Dental Plan Operations Manager to address operational needs across departments, including support for enrollment, call center activities, and claims payment processes.

REQUIRED QUALIFICATIONS

Education: Associates in business, management or healthcare administration or related field.

Skills: Strong analytical skills for reviewing data and identifying trends. Able to solve complex problems using sound reasoning. Exceptional writing skills for creating clear reports and professional communication. Understands the importance of professionalism, especially when working with outside companies. Skilled in Microsoft Office programs including Excel, Word, PowerPoint, Access, SharePoint, Salesforce, and Microsoft Project. Able to draft reports and communicate effectively by phone, in writing, and in person. Able to organize and manage multiple tasks independently.

Years of Experience: 1-2 years of experience working in the dental or health insurance industry.

PREFERRED QUALIFICATIONS

Education: Bachelors in business, management or healthcare administration or related field.

Years of Experience: 3-5 years of experience in a dental or health plan environment, with direct involvement in areas such as claims administration, enrollment processes, call center operations or similar high-level functions.

The above list of accountabilities is intended to describe the general nature and level of work performed by the positions; it should not be considered exhaustive.

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or other status protected by applicable law.

Equal Opportunity Employer/Drug-Free Workplace

ProMedica is a mission-driven, not-for-profit health care organization headquartered in Toledo, Ohio. It serves communities across nine states and provides a range of services, including acute and ambulatory care, a dental plan, and academic business lines. ProMedica owns and operates 10 hospitals and has an affiliated interest in one additional hospital. The organization employs over 1,300 health care providers through ProMedica Physicians and has more than 2,300 physicians and advanced practice providers with privileges. Committed to its mission of improving health and well-being, ProMedica has received national recognition for its clinical excellence and its initiatives to address social determinants of health. For more information about ProMedica, please visit promedica.org/aboutus.

Benefits:

We provide flexible benefits that include compensation and programs to help you take care of your family, your finances and your personal well-being. It's what makes us one of the best places to work, and helps our employees live and work to their fullest potential.

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org

Equal Opportunity Employer/Drug-Free Workplace