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Provide consultation and analysis related to dental insurance products, pricing/fee-schedules, utilization, and capacity (internal and external) to Dental Vice President, Directors and Dental Program management.
Essential Functions:
- Provides financial, utilization analysis, and project management related to all program insurance plans, but with a special focus on PPO and any Fee-For-Service products.
- Provides analysis and project management related to internal and external fee schedules and product pricing.
- Plays major role in process development and deployment of new dental program products and business lines.
- Provides analysis, reporting and consultation related to the design, implementation and management of the program's insurance needs and external provider networks.
- Cross trains and serves as back-up resource for dental insurance consultants.
- Claims adjudication for out of area and community referral claims.
- Analyzing and processing claims from members and community providers.
- Communication to health plan and dental care delivery staff, and external communication to community providers and members.
- Administer and adjudicate provider database.
- Process payment remittance.
- Enters treatment into member's dental record and administers explanation of benefits process for members.
- Cross trains and serves as back-up resource for dental insurance consultants.
- Provides oversight & solutions to assist Dental Program in meeting financial targets, participates in monthly financial reviews, researches variances, consults with managers in developing operational/financial plans, and recommends improvements.
- Participates in the program's Rate Setting and Operational Budget work.
- Cross trains and serves as a backup resource during the budget processes.
- Provides analysis and project management related to internal and external fee schedules and product pricing.
- Facilitates staff training and cross-training and mentors analytical staff, other duties as assigned.
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