As a Dental Standards Specialist, you will support Field Sales offices, Underwriting, Group Benefits Service Center, Training, and Dental Claim processing with information regarding dentistry, legislation, contractual guidelines, workflows, and system capabilities. Additionally, as part of the Dental Product Team you will
- Perform detailed evaluations of prior dental plans to determine necessary contractual and system changes to assist in the sale of new business.
- Review state legislation and implement necessary workflows and correspondence.
- Assist in the development of new products and in the development, completion and monitoring of special projects.
- Self-driven with a history of collaboration across cross-functional areas and possess the ability to challenge and make decisions faced in doing work, improving processes or meeting customer needs.
- Bachelor’s degree preferred.
- At least 5 years of experience in the insurance industry.
- Preference of extensive dental claim processing or dental related customer service experience.
- Exemplary knowledge of dental claim processing procedures.
- Superior knowledge of dental terminology, Current Dental Terminology (CDT) codes, clinical rationale, and policies of dental procedures.
- Knowledge of PPO/DHMO administration, policies, and guidelines.
- Must have the ability to adapt to constantly changing priorities in highly productive environment, think analytically and be very detailed oriented.
- Individual must possess excellent organizational skills; written and oral communication skills; interpersonal communications; and be highly motivated.
- Must be able to effectively interact with multiple levels of personnel from all internal and external customers.
- Review prospective client’s plan requirements, developing the appropriate plan design to enable Guardian to be awarded the client’s business.
- Provide necessary contract wording, plan provisions and plan exceptions to sales and underwriting for approval and determine system requirements for non-standard benefits.
- Provide feedback on the rating impact on special plans to actuaries and underwriters when requested.
- Assist in dentist/member complaint resolution. Identify alternative solutions and make quick, but thoughtful decisions to resolve client issues. Work to prevent future recurrence of internal and external customer issues.
- Identify discrepancies and recommend changes based on dentistry, industry standards, contract provisions, research and consider the implications to all departments and dental products.
- Obtain input as necessary from business partners, including Dental Claim Processing, Customer Response Unit (CRU), Group Business and Implementation Services, Customer Experience & Quality, Network Administration and Provider Recruiting.
- Notify appropriate areas, assist in implementation, and ensure the accurate implementation of changes.
- Interpret and determine necessary procedures to ensure compliance and document legislation compliance processes.
- Communicate legislative requirements and obtain input from business partners as necessary to development workflows and necessary correspondence.
- Identify potential Claims system and Dental Review Logic (DRL) modifications and enhancements necessary to expand our dental business and accommodate new products, special projects, and plan designs.
- As our Dental Standards Specialist, you will report to our Dental Standards Manager, who reports to our Head of Dental and Vision Products.
Location & Vaccination Requirements
- The primary location for this position is remote, with an “at home” work arrangement.
- Covid – 19 vaccinations not required unless you voluntarily visit one of our campus locations or are attending an in-person company sponsored event.
- Occasional Travel required for this position.
- Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.
- Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
- Competitive compensation package.
- Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
- Life and disability insurance.
- A great 401(k) with company match.
- Tuition assistance paid parental leave and backup family care.
- Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
- Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
- Employee Resource Groups that advocate for inclusion and diversity in all that we do.
- Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.
Guardian has been helping people protect their futures and secure their lives for 160 years. Every day, we serve approximately 29 million people through a range of insurance and financial products. We help people and their families pursue financial security and well-being in life, health, and wealth. We help companies take care of their employees. And we help people recover and thrive after unexpected loss.
From our founding in 1860, when a community of immigrants joined together to insure and protect their businesses and families, doing the right thing for our policyholders and customers has guided everything we do. Our dedication to customers has helped us remain one of the most highly rated in client satisfaction and financial strength. And as one of the largest mutual insurance companies, we know what matters most: putting the needs of our customers first. Because everyone deserves a Guardian. Learn more about Guardian at www.GuardianLife.com.
© Copyright 2021 The Guardian Life Insurance Company of America, New York, NY
Equal Employment Opportunity
Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.
Job Type: Full-time
- 401(k) matching
- AD&D insurance
- Dental insurance
- Disability insurance
- Health insurance
- Life insurance
- Unlimited paid time off
- Vision insurance
- Work from home
Work Location: Remote