Insurance Operations Manager; Hybrid

At Dental Associates, we foster a culture which invites our patients into our "dental home" and provides our employees with a career, not just a job. Founded in 1974, Dental Associates is Wisconsin's largest family and dentist-owned dental group practice with over a dozen offices throughout the state. Dental Associates is a strong company with the resources to continually invest in our overall growth and talented team members.

Chartered in 1983, Care Plus Dental Plans, Inc. is the vertically integrated dental insurance arm of Dental Associates, offering both group and individual dental plans to over 45,000 members in the state of WI.

• Schedule
  :
  Full-time, 40 hours per week (Monday-Friday)
• Hybrid Work Arrangement
  :
  Initially in office, with potential to transition to 3 days in the office and 2 days remote

We are seeking an experienced benefits manager to oversee benefits administration, data analytics, and the insurance technology platform for Care Plus Dental Plans, the vertically integrated dental insurance arm of Dental Associates. The ideal candidate will be an analytical self-starter who excels at problem solving and attention to detail. The Care Plus Insurance Operations Manager will act as a liaison between our service, technical, and operations staff, with a core focus on providing excellent administrative support to our clients and provider partner, Dental Associates.

• Build strong relationships within the business units and support functions to better serve our members.
• Create, transmit, import, adjudicate and pay claims for timely processing.
• Process claims specific to the agreed upon benefits and fee schedules by plan, reviewing clinical documentation as needed.
• As appropriate, determine alternate benefits for services that do not meet processing guidelines.
• Ensure the accuracy of claim payment for all claims processed through the extended provider network.
• Submit out of network claim payment approvals, including supporting documentation within protocol.
• Communicate denial reasons with providers and patients per policy guidelines.
• Collaborate with leadership to establish work standards and objectives with Major Work Coordinators.
• Identify and report potential fraud and abuse cases.
• Identify and translate business needs into clearly defined requirements for insurance policy administration projects.
• Manage client relationships including but not limited to initial set up, ongoing processing and troubleshooting of HIPAA 834 electronic enrollments and ACH transfers.
• Create and maintain documentation, including HIPAA 834 Companion Guides.
• Handle analysis, audits and supervisor support for Dental Associates’ Billing Department upon request.
• Configure benefits within the Skygen Insurance and Denticon Practice Management systems, including plan structure and fee schedules.
• Lead software testing, documentation and validation periodically, in preparation for software upgrades.
• Collaborate with team members on system enhancements, ensuring that proposed solutions improve efficiency and the effectiveness of business processes.
• Identify software performance issues, obtaining resolution through working with vendors.
• Evaluate reporting for accuracy, resolving inaccuracies with IT and third-party administrators.
• Other duties as assigned.

As a team member of Care Plus Dental Plans at Dental Associates you can expect excellent compensation, experience on-the-job training, continued education offerings and abundant opportunities for career growth.

• Flexible PTO
• Medical Insurance with optional Health Savings Account through Associated Bank
• Dental:
  Diagnostic and Preventive covered at 100%, Basic and Restorative (immediate family)
• Vision Insurance
• Life Insurance
• 401k
• Company paid short term disability
• Paid Holidays
• FSA
• Critical Illness
• Hospital Indemnity
• Pet Insurance

• Ability to work collaboratively with key internal and external leaders, partners, payers, and customers in a fast-paced environment.
• Excellent interpersonal, communication, and organizational skills. Demonstrate professional and ethical standards to gain and maintain credibility.
• Ability to…