Dental Customer Care-Claims Specialist

Medical Mutual employees must submit their applications through MySource.

Note: This role is remote with a quarterly on-site requirement in Centerville, Ohio. Must reside within the Dayton/Cincinnati, Ohio area.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Dental Customer Care-Claims Specialist I

Job Summary:

Works under direct supervision within the dental claims and customer care department. This blended role handles inbound calls from members, providers, clients, employers, and brokers, while also processing routine dental claims in accordance with established performance expectations, service philosophy, and service level agreements.

Responsibilities:

• Utilizes multiple systems, applications, and reference tools, provides customer services via inbound call queues, while also processing routine dental claims.
• Performs other duties as assigned.

Dental Customer Care-Claims Specialist II

Job Summary:

Works under limited supervision within the dental claims and customer care department. This blended role, handles inbound calls and written inquiries (multiple channels) from members, providers, clients, employers, and brokers, while also processing routine to moderately complex dental claims in accordance with established performance expectations, service philosophy, and service level agreements.

Responsibilities:

• Utilizes multiple systems, applications, and reference tools, provides customer service via inbound call queues and various channels of written communications (such as email, chat, and portal inquiries) while also processing routine to moderately complex dental claims and adjustments.
• Under the direction of more senior staff, conducts dental claims or inquiry-related research.
• Assists with projects as directed by management.
• Performs other duties as assigned.

Qualifications:

Dental Customer Care-Claims Specialist I

• Associate's degree in business or healthcare administration, communications or related field.
• Equivalent education and experience directly related to the role may substitute for a degree.
• 1 year customer service and/or claims experience, preferably in a call center in the health or dental insurance industry, or a dental providers office.
• Certified Dental Billing Specialist (CDBS), Certified Dental Coder (CDC), or Certified Dental Assistant (CDA) a plus.
• Basic Microsoft Office skills.
• Basic knowledge of dental benefits, services, terminology, and American Dental Association coding.
• Knowledge of standard customer service best practices and principles.
• Knowledge of Heath Insurance Portability and Accountability Act (HIPAA).

Dental Customer Care-Claims Specialist II

• Associate's degree in business or healthcare administration, communications or related field.
• Equivalent education and experience directly related to the role may substitute for a degree
• 2 years of experience as a Customer Care/Claims Specialist or equivalent customer service experience, preferably in dental insurance, dental providers office, or the healthcare/health insurance industry.
• Certified Dental Billing Specialist (CDBS), Certified Dental Coder (CDC), or Certified Dental Assistant (CDA) a plus.
• Basic to intermediate Microsoft Office skills.
• Solid knowledge of dental benefits, services, terminology, and American Dental Association coding.
• Knowledge of standard customer services best practices and principles.
• Knowledge of Heath Insurance Portability and Accountability Act (HIPAA).

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.