Customer Service Associate

Job Summary

A Customer Service Agent following established company guidelines resolves customer issues received by telephone, mail or fax from group administrators, subscribers and dentists. An Agent explains Delta Dental 's group contracts, agreements, processing policies and procedures. An Agent can also adjudicate dental claims and resolve adjustments.

A Customer Service Agent following established company guidelines resolves customer issues received by telephone, mail or fax from group administrators, subscribers and dentists. An Agent explains Delta Dental 's group contracts, agreements, processing policies and procedures. An Agent can also adjudicate dental claims and resolve adjustments.

To help you determine whether this opportunity is a match for you, please note the following:

• This is a hybrid role with required onsite attendance in our Parsippany, NJ office every Tuesday and Wednesday.
• The working hours for this position are 10:00 a.m. to 6:30 p.m. Monday through Thursday and 9:00 a.m. to 5:00 p.m. on Fridays.
• Your first six weeks will be dedicated to onboarding and training, which will be conducted remotely Mon, Thurs, Friday and on site Tues/Wed. The training schedule will be provided before your first day.
• This position is expected to begin on October 12, 2026.

• Adhering to the Agent’s schedule, the Agent is required to be available on the call center ACD to answer customer calls while meeting and exceeding department KPI’s.
• As a team member, researches and resolves inquiries and responds to customers with an appropriate and accurate written or verbal notification.
• Calculates adjustments and creates and processes claims for adjusted payments.
• Creates and processes standard claims, claims with coordination of benefits, pre-treatment estimates, and pretreatment estimates with dated services.
• Maintains and updates subscriber files with information obtained through inquiries and submitted claims and documents, i.e., individual and family on hold codes, applied or removed.
• Performs all tasks necessary to resolve all questions based on Delta Dental’s claims processing guidelines and Dentist handbook, as well as Delta Dental’s website and mobile application.
• Documents each inbound call in call tracking, follow up, or any pended requests.
• Generates check research requests for outstanding payments.
• Understands all claim guidelines and effectively uses this information to resolve related inquiries.
• Researches and resolves requests from other departments such as Marketing and Enrollment.
• When necessary, refers claims or subscriber eligibility to Management or other departments such as Professional Services, Claims, Marketing and Enrollment.
• Supports and participates as needed for inventory reduction tasks such as correspondence and/or call tracking.
• Other duties as assigned

• Adaptability/Flexibility
• Communication
• Computer Skills
• Customer Focus
• Dependability
• Job Knowledge
• Productivity
• Quality
• Teamwork

• Adherence standard is 96%
• After call work time – 10 seconds
• Quality: 99%

• Ability to regard customer service excellence as a priority
• Personal computer skills with knowledge of MS applications such as Windows, Word and Excel and browser based applications such as Internet Explorer
• Excellent communication and listening skills
• Excellent math aptitude
• Creativity and flexibility when solving problems
• Ability to work in an environment where work is carefully monitored for accuracy

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.…