Operations Analyst

Delta Dental of Rhode Island is seeking an Operations Analyst to support operational processes involving client setup, system configuration, claims resolution, quality control, testing, and reporting. The role also serves as a resource for client-related inquiries, assists with claims processing oversight, and participates in special projects and system release evaluations.

What you'll do:

• Record system transactions to account for any changes in a client’s general and/or benefit information
• Quality control checks of all system transactions
• Serves as a resource to the organization regarding processing of client related information and transactions
• Maintain and process client renewal transactions
• Research and configure system rules based off client benefit modifications, CDT updates and companywide policy changes
• Propose new innovative rules to Management that enhance the claim processing system that will help build efficiencies and increase accuracy
• Plans, allocates, and monitors workflow to assure the accurate and timely completion of assignments within established production and inventory standards
• Assists in the oversight of the processing and adjudication of claims by guiding the activities of the claims analysts; monitors and communicates corporate policies and procedures to assure a high level of accuracy and completeness within established production and inventory standards
• Researches any unusual payments and refunds; processes the most complex type of claims which involve judgment and interpretation based on precedent, knowledge of the dental terminology, and a thorough understanding of the Corporation’s claims processing policies and procedures
• Research and resolve potential client overpayments and underpayments
• Performs the overpayment recovery process to recoup overpayments made to the dentists
• Interact regularly with Customer Service to answer claim-related questions

What they're looking for:

• High School Diploma or equivalent
• Excellent communication and organizational skills
• Attention to detail and accuracy
• 40-hour workweek (M-F) as assigned and additional hours as required
• Associates or Bachelor's degree
• Prior knowledge of database programs preferred

Benefits:

• Extensive training in claim, eligibility, and provider functions as well as workstation training.