Dental Quality Operations Specialist

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Job Summary:

The Dental Quality Operations Specialist supports the operation quality and compliance functions of the dental plan by coordinating activities across multiple teams and ensuring adherence to industry standards and regulatory requirements.

ACCOUNTABILITIES

• Grievances Appeals & Complaints. Acts as the main contact for member and provider grievances appeals and complaintshandling intake acknowledgement investigation coordination with internal departments and Health Plan Partner and issuing timely responses per policies and regulations.
• Quality Management Program. Supports the Quality Management (QM) program and facilitates the QM Committee following the direction of the Dental Plan Operations Manager; responsible for establishing annual initiatives with the committee coordinating resources and ensuring key projects and priorities progress throughout the year.
• Operations Coordination. Works under the direction of the Dental Plan Operations Manager to address operational needs across departments including support for enrollment call center activities and claims payment processes.

REQUIRED QUALIFICATIONS

Education: Associates in business management or healthcare administration or related field.

Skills: Strong analytical skills for reviewing data and identifying trends. Able to solve complex problems using sound reasoning. Exceptional writing skills for creating clear reports and professional communication. Understands the importance of professionalism especially when working with outside companies. Skilled in Microsoft Office programs including Excel Word PowerPoint Access SharePoint Salesforce and Microsoft Project. Able to draft reports and communicate effectively by phone in writing and in person. Able to organize and manage multiple tasks independently.

Years of Experience: 1-2 years of experience working in the dental or health insurance industry.

PREFERRED QUALIFICATIONS

Education: Bachelors in business management or healthcare administration or related field.

Years of Experience: 3-5 years of experience in a dental or health plan environment with direct involvement in areas such as claims administration enrollment processes call center operations or similar high-level functions.

The above list of accountabilities is intended to describe the general nature and level of work performed by the positions; it should not be considered exhaustive.

Qualified applicants will receive consideration for employment without regard to race color national origin ancestry religion sex/gender (including pregnancy) sexual orientation gender identity or gender expressionage physical or mental disability military or protected veteran status citizenship familial or marital status genetics or other status protected by applicable law.

Equal Opportunity Employer/Drug-Free Workplace

ProMedica is a mission-driven not-for-profit health care organization headquartered in Toledo Ohio. It serves communities across nine states and provides a range of services including acute and ambulatory care a dental plan and academic business lines. ProMedica owns and operates 10 hospitals and has an affiliated interest in one additional hospital. The organization employs over 1300 health care providers through ProMedica Physicians and has more than 2300 physicians and advanced practice providers with privileges. Committed to its mission of improving health and well-being ProMedica has received national recognition for its clinical excellence and its initiatives to address social determinants of more information about ProMedica please visit provide flexible benefits that include compensation and programs to help you take care of your family your finances and your personal well-being. Its what makes us one of the best places to work and helps our employees live and work to their fullest potential.

Qualified applicants will receive consideration for employment without regard to race color national origin ancestry religion sex/gender (including pregnancy) sexual orientation gender identity or gender expression age physical or mental disability military or protected veteran status citizenship familial or marital status genetics or any other legally protected compliance with the Americans with Disabilities Act Amendment Act (ADAAA) if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica please contact

Equal Opportunity Employer/Drug-Free Workplace