Delta Dental of Arkansas

• Manage incoming calls and customer service inquiries. • Provide outstanding customer service that meets the needs of the department standards and performance metrics. • Demonstrate exceptional verbal and written communication. • Build relationships and trust with customers through open and interactive communication. • Learn, retain, and effectively use appropriate systems, programs, and dental knowledge to resolve inquiries. • Access and utilize reference material and other resources to analyze and determine appropriate responses to complex telephone, electronic, and written inquiries. • Create thorough call documentation and follow up on open calls to ensure resolution is achieved within agreed upon standards. • Continuously evaluate and identify opportunities to drive process improvement that increase customer satisfaction. • Must clock in and out as scheduled.

• Research incoming appeals, grievances and complaints, including consideration and reconsideration requests, to properly identify and categorize as processed claims (grievances), denied services (appeals or self-funded (ASO) group requests) or complaints • Collect all appropriate data and information, and process for clinical or contract consideration as appropriate. • Coordinate case review with dental consultants. • Coordinate timely handling and resolution responses for high volume of appeals and grievances within various regulatory and contractual timelines • Reconcile across systems to ensure that all member appeals and grievance are logged and tracked. • Direct external independent reviews to the appropriate independent review organization (IRO) • Document records in accordance with DOI guidance requirements • Prepare and manage all monthly and quarterly customer and internal reporting • Communicate effectively with other departments such as Claims and Customer Service, Billing & Eligibility, Marketing and Professional Relations to ensure complete and fair reviews of complaints, grievances and appeals