Government Programs Implementation Specialist

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Job Summary:

At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities for all. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.

At Delta Dental, we celebrate our All In culture. It’s a mindset, feeling and attitude we wrap around all that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community. 

Job Summary:

To assist in the implementation of Government Programs clients as well as oversee and/or assist with program changes at renewal to ensure obligations are met.

Primary Job Responsibilities:

• Assists the Government Programs Implementation Lead with new client implementations including, but not limited to, project plan oversight, external and internal meeting involvement, system set-up, review and analysis of CMS bid, client benefit plan description and/or government agency benefit guides, member and/or provider communications and/or mailings, understand billing requirements and assist with facilitation of contract negotiations.

• Establishes and identifies tasks and timelines to ensure all requirements are completed by the effective date of the contract.

• Provides administrative support to internal and external clients, but not limited to general and government program related inquiries, claims history cross check, customer service requests and focused review requests.

• Assists in reviewing and updating group communication documents.

• Assists in the renewal process of existing Government Programs clients.

• Collaborates with health plans and/or third party administrators to assist with obtaining eligibility and benefit description.

• Assists with monitoring client eligibility and benefit design and provides final approval of data entered into Roosevelt.

• Reviews and aids in determining resolutions for production issues including, but not limited to, billing, claims payment, and client contracts.

• Assists with the review and update of departmental procedures.

• Participates in testing and end-user training for system functionality.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

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Minimum Requirements:

Position requires a bachelor's degree with coursework in business administration or a related field and three years' related work experience in a health insurance, customer service or sales environment. Experience with Government Programs is preferred. Will accept any suitable combination of education, training, or experience.

Position requires basic knowledge of health insurance administration, group contract, summary plan and certificate language, and claims processing; intermediate knowledge of desktop software including spreadsheets, word processing, and presentation software; effective verbal and written communication skills.

The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.