Dental Network Provider Relations Specialist

Careington International is a solutions-oriented company. An established leader, we have been a trailblazer in the field of discount health care since 1979. Over the years, our mission has remained the same, to create discount health programs that are marketable to the employer, profitable to the provider and economical for the member. In response to a growing demand for our products and services in recent years, our growth means that we continuously strive to recruit innovators to join our fast-paced, forward-thinking team.

We are based in Frisco, TX and employ prospective candidates that are able to work in a Hybrid work arrangement, 3 days in the office per week, Tuesday through Thursday, from 8 : 00 to 5 : 00 If you are looking for a great company culture filled with rewarding career advancement opportunities, this is the place for you.

The Dental Network Provider Relations team is the primary liaison between Careington and our individual dental offices, and a key component to educating and assisting our providers on a day-to-day basis. This role also involves working with network development’s other core divisions like credentialing and recruitment, as well as working externally with Careington’s clients and their provider relations departments.

Individuals who have prior experience within the dental or medical insurance industry are strongly encouraged to apply.

Duties & Responsibilities :

Act as liaison between providers, members, and act as the dedicated liaison for assigned clients

Answer phone calls from providers and handle inquiries in real time

Resolve provider calls effectively and efficiently, with the intent for one-call-resolutions when possible

Contact provider offices to resolve member billing and quality of care grievances

Negotiate refunds from provider offices on behalf of the member if overbilling has occurred

Professionally write resolution letters due to member billing or quality of care inquiries

Educate provider offices on plan administration, plan participation, and other facets of Careington’s network by phone

Work with marketing and team to create education materials and distribute them to the network

Audit offices for participation and plan administration

Work with compliance on addressing escalated issues

Willing to perform all other responsibilities as assigned and assist in other department projects as needed

Maintain a thorough working knowledge of Careington’s Network Development department and functions

Knowledge, Skills, and Abilities :

Must be a self-motivator with a high desire to add value to the day to day operations of the department

Possess high level problem solving and analytical thinking skills that will assist in making independent judgment decisions to provider / member inquiries

Strong conflict resolution skills to de-escalate

Have a strong sense of time management and organizational skills with the ability to effectively manage various daily tasks

Must be able to retain and apply learned information to all request presented

A strong knowledge of basic mathematical calculations is required

Impeccable communication skills – both written and verbal

Must have professional phone demeanor and superb listening skills for callers

Minimum Qualifications and Requirements :

Proficient within MS Office Suite products : Word, Adobe, Excel, Outlook

Phone experience; engaging with inbound callers

• Dental or medical insurance industry knowledge is a plus