Operations Analyst

Delta-Denta; Providence (RI); On-site; USD 60,000 - 75,000; Full time

Job summary

Delta-Denta in Providence, RI is seeking an Operations Analyst to join the Operational team. This full-time role supports client setup, system configuration, claims resolution, and quality control of client transactions; you will respond to inquiries across departments and help ensure accurate processing.

The ideal candidate will handle client data changes, renewals, and rule configurations, while contributing to process improvements and cross-functional collaboration within a 40-hour workweek.

Qualifications

• High School Diploma or equivalent; Associates or Bachelor’s degree preferred.
• Excellent communication and organizational skills.
• Attention to detail and accuracy.
• Prior knowledge of database programs preferred.

Responsibilities

• Record system transactions to account for changes in a client’s general and/or benefit information.
• Quality control checks of all system transactions.
• Maintain and process client renewal transactions.
• Research and configure system rules based off client benefit modifications, CDT updates and companywide policy changes.
• Assist in oversight of the processing and adjudication of claims by guiding the activities of the claims analysts; monitors and communicates corporate policies and procedures to assure a high level of accuracy and completeness within established production and inventory standards.
• Interact regularly with Customer Service to answer claim-related questions.
• Becomes knowledgeable with analytical tools and collaborates/recommends new operational reports to Data Analytics team.
• Responsible for the quality of various operations department tasks including rule updates, coordination of benefit processing, ortho claims, internally entered claims pretreatments and client data management.
• Assists in the evaluation of all system releases to ensure accuracy and completion.
• Participates in pre-release testing with Project Management
• Participates in special projects as required by management.
• Performs other duties as assigned.

Skills

Excellent communication

Organizational skills

Attention to detail

Database concepts

Education

High School Diploma or equivalent

Associates or Bachelor's degree preferred

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Operations Analyst

Full Time Providence, RI, US

2 days ago Requisition ID: 1076

POSITION SUMMARY: This position is an integral part of the Operational team. In this role, the analyst will assist in various Operational processes including; new client setup, management of client, system configuration, claims resolution, and quality control of client related transactions. This individual will be a key resource to answer inquiries from other areas throughout the company.

Essential Functions:

Client Setup

• Record system transactions to account for any changes in a client’s general and/or benefit information.
• Quality control checks of all system transactions.
• Serves as a resource to the organization regarding processing of client related information and transactions.
• Maintain and process client renewal transactions.

System Configuration

• Research and configure system rules based off client benefit modifications, CDT updates and companywide policy changes.
• Propose new innovative rules to Management that enhance the claim processing system that will help build efficiencies and increase accuracy.
• Plans, allocates, and monitors workflow to assure the accurate and timely completion of assignments within established production and inventory standards.
• Assists in the oversight of the processing and adjudication of claims by guiding the activities of the claims analysts; monitors and communicates corporate policies and procedures to assure a high level of accuracy and completeness within established production and inventory standards.
• Researches any unusual payments and refunds; processes the most complex type of claims which involve judgment and interpretation based on precedent, knowledge of the dental terminology, and a thorough understanding of the Corporation’s claims processing policies and procedures.
• Research and resolve potential client overpayments and underpayments.
• Performs the overpayment recovery process to recoup overpayments made to the dentists.
• Interact regularly with Customer Service to answer claim-related questions.

Data Analysis and Reporting

• Becomes knowledgeable with analytical tools and collaborates/recommends new operational reports to Data Analytics team.

Quality Control

• Responsible for the quality of various operations department tasks including rule updates, coordination of benefit processing, ortho claims, internally entered claims pretreatments and client data management.

Testing

• Assists in the evaluation of all system releases to ensure accuracy and completion.
• Participates in pre-release testing with Project Management

Other Duties

• Participates in special projects as required by management.
• Performs other duties as assigned.

Requirements:

• High School Diploma or equivalent; Associates or Bachelor’s degree preferred.
• Excellent communication and organizational skills.
• Attention to detail and accuracy.
• Prior knowledge of database programs preferred.

Entry Level Training Received (If any)

• Extensive training in claim, eligibility, and provider functions as well as workstation training.

Work Environment / Physical Demands:

• Typical office environment
• 40-hour workweek (M-F) as assigned and additional hours as required