Enrollment Associate
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, 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. ** see below for additional benefit information.
Job Summary
The Enrollment Associate performs diversified duties in regard to eligibility verification and processing functions to ensure accurate records necessary for billing and claims adjudication purposes.
Essential Functions & Responsibilities
- Reviews, evaluates, and enters eligibility adjustments and updates into the eligibility system or capitation system accordingly.
- Prepares correspondence/reports for group administrators and/or brokers with regard to eligibility situations.
- Researches claims that have pended for eligibility reasons to support timely claims processing.
- Reviews and approves all electronic group files to update the production system.
- Responds and follows up with benefit administrators/Brokers/TPA’s by telephone and/or e-mail to verify eligibility, report problems with an electronic file or manual enrollment requests. In addition responds to eligibility and billing questions.
- Processes corrections from the electronic group data.
- Reviews, processes and/or makes corrections from daily eligibility reports.
- Handles billing inquiries by providing exceptional service via telephone and corresponding with benefit administrators/Brokers or TPA’s.
- Researches and resolves billing errors in a timely manner.
- Performs account audits upon request.
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
- Average updates per month: 56
- Quality; 99%
- Abandon Rate: 3% or below
- ASA: 20 Seconds or below
- Files per hour: 12 and above
- Adherence: 96%
Technical and Functional
- Ability to work effectively with benefit administrators, brokers and staff members
- Excellent verbal and written correspondence skills
- Good keyboard skills
- Strong math aptitude
- Good analytical ability
- Must possess a positive attitude and the ability to work cooperatively in a team environment
- Above average ability to retain knowledge toward claim processing system, eligibility system and group contact eligibility requirements
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 deadlines and attendance standards.
- 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
- One (1) year clerical experience, insurance industry preferred
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.
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