Join the #1 company in New York's dental insurance market! Healthplex offers excellent career opportunities in an organization that provides career advancement and training programs while recognizing and rewarding strong performance. We offer competitive compensation and benefits packages and new executive management is dedicating time and resources to making Healthplex the best place to work on Long Island.

Current Career Opportunities

Bilingual Customer Service Representative

Position Title:

Bilingual Customer Service Representative

Reports To:

Director of Customer Service

FLSA Status:

Full Time

Summary:

A Bilingual Customer Service Representative must be able to speak/read/write in English as well as one of the following: Spanish, Russian, Mandarin, or Cantonese. A Bilingual Customer Service Representative assists our members in an inbound call center by investigating and responding to all member inquiries regarding dental plan coverage, status of claims, provider information, and any other information that will assist our members. Customer Service Representatives are full time employees scheduled for 35 hours a week. We are currently looking to fill positions for Monday-Friday from 10:30am to 6:00pm. Paid training will be the first seven business days of employment from 9:00am to 4:30pm.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Efficiently answer inbound calls while resolving member issues concerning their dental coverage
Handle irate customers in a professional manner
Adhere to all attendance/punctuality policies and procedures
Absorb and retain information to ensure consistency when explaining benefits, regulatory items, and policy and procedures
Meet or exceed standards of quality and professionalism as set by both Healthplex and the NCQA
Provide professional and courteous service to all lines of business
Ensure consistency and adherence to departmental work flows, policy and procedures
Follow appropriate avenues of protocol to elevate issues
Input comments regarding customer issue and relative data into the database
Call customers when necessary to advise on next steps and/or inform of resolution
Obtain customer feedback information and multi task while on the phone

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

High School diploma or GED. Preferred Experience: 1 year of Customer Service Call Center experience. Experience working in Dental Office and/or HMO/Insurance

Computer Skills:

Basic computer skills as well as quick and accurate typing skills.

Other Skills:

Fluent (speak/read/write) in English as well as Spanish, Russian, Mandarin, or Cantonese. Excellent communication skills (good grammer, voice, and diction). Excellent customer service skills (friendly, courteous, and helpful).

Apply Now

Credentialing Assistant

Position Title:

Credentialing Assistant

Reports To:

Director of Credentialing - Healthplex, Inc.

FLSA Status:

Non-Exempt, Non-Union

Summary:

A Credentialing Assistant processes provider information as directed and provides general administrative support to the Credentialing department.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Performs application data entry with strong attention to detail.
Handles follow-up phone calls to providers.
Primary source verification for state licenses, DEA certificates, malpractice insurance and sanctions
Mailing of provider applications.
Filing and scanning of provider information.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

High school diploma or GED

Computer Skills:

Basic computer skills. Familiarity with a keyboard. Excellent verbal communication skills and phone etiquette.

Other Skills:

All qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.

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Credentialing Representative

Position Title:

Credentialing Representative

Reports To:

Director of Credentialing

FLSA Status:

Non-Exempt

Summary:

A Credentialing Representative processes provider information to ensure credentials meet NCQA and JCAHO guidelines.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Enter provider information from credentialing application into the Cactus database
Contact providers to request any additional or missing information needed to complete application
Run Queries in Cactus to pull providers that require certain documents to be submitted in between credentialing cycles.
Conduct internet searches to verify providers? credentials and compare results with guidelines to ensure provider meets criteria to join panels.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

Associate's degree (A. A.) or one to two years? related experience and/or training or equivalent combination of education and experience.

Computer Skills:

Microsoft Outlook, Excel, Word, Internet. Knowledge of Visual Cactus and Crystal Reports helpful.

Other Skills:

Apply Now

Customer Service Representative

Position Title:

Customer Service Representative

Reports To:

Director of Customer Service

FLSA Status:

Full Time

Summary:

A dental Customer Service Representative receives, investigates and responds to all customer inquiries regarding dental plan coverage, status of claims and provider information.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Talk with customers by phone concerning dental plan coverage issues.
Input comments regarding customer issue and relative data into the database.
Call customers when necessary to advise on next steps and/or inform of resolution.
Handle irate customers in a professional manner.
Obtain customer feedback information.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

High school diploma or GED.

Computer Skills:

Basic computer and keyboarding skills.

Other Skills:

Knowledge of dental procedures and terminology. Excellent communication skills. Good grammar, voice and diction. Bi-lingual English/Spanish/Russian helpful. Excellent customer service skills (friendly, courteous and helpful).

Apply Now

Data Entry Processor

Position Title:

Data Entry Processor

Reports To:

Claims Manager

FLSA Status:

Union; Non-Exempt; Full-Time

Summary:

A Data Entry Technician in the Claims Department is responsible for accurately entering data from claim forms.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Accurately enter high volume of dental claims data into company database.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

High school diploma or GED

Computer Skills:

Strong Data Entry Skills. Minimum data entry speed of 10,000 + keystrokes per hour required.

Other Skills:

Punctual, reliable, strong attention to detail skills required. All qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.

Apply Now

Dental Claims Processor

Position Title:

Dental Claims Processor

Reports To:

Claims Manager

FLSA Status:

Non-Exempt; Full Time

Summary:

A Dental Claims Processor adjudicates dental claims based on summary plan descriptions.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Sort, count and record daily mail into groups and seperate claims that need to be reviewed by dental consultant (x-rays)
Adjudicate claims according to group guidelines. Review member history, eligibility, student status, coordination of benefits, fee schedules, member address, doctor address and other information to verify correctness.
Ensure adjudication of claims within Claims Department time restrictions (and/or alert supervisor/manager before work load falls behind these restrictions)
Review and process electronic claims
Confer with dental consultants regarding high priority cases and/or unclear treatment plans.
Review check runs for accuracy. Make necessary adjustments when errors are found, including tagging checks for voiding.
Enter coordination of benefits information.
Handle claim adjustments taken by Customer Service and placed in daily Claims adjustment folders.
Assist group representatives with questions regarding eligiability, claim issues and plan guidelines when advised by Supervisors.
Research to find correct address when EOB's and checks are returned. When applicable, make corrections and resend.
Return claims to provider/member when essential information has been omitted from the claim form.
Make sure claim numbers and member name/identification numbers are written on all attachments to claim and given to the imaging department on a daily basis.
Fill out refund request forms and type refund request letters regarding overpayments made to members and/or providers.
Act as a back up to another processor (sorting and processing precerts and claims) when the other processor is absent.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

One year certificate from college or technical school; or three to six months related dental assisting and/or insurance billing experience and/or training; or equivalent combination of education and experience.

Computer Skills:

Knowledge of Database software, strong alpha-numeric data entry skills.

Other Skills:

Knowledge of ADA codes, dental procedures and terminology.

Apply Now

Dental Director

Position Title:

Dental Director

Reports To:

Director of Operations

FLSA Status:

Exempt

Summary:

The primary responsibility of the Dental Director is to create and maintain the Healthplex clinical criteria for UM decision-making as well as oversee all functions of the staff of Clinical Reviewers.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Maintains the Healthplex Professional Guidelines for Review of Services for Dental Plans which outlines the criteria for rendering a clinical determination including the specific criteria for issuing a denial for a requested service or treatment based on medical necessity.
Analyzes complaints, quality of care concerns, and appeal requests for denied services and renders a determination.
Identifies and participates in investigations of submission patterns, quality of care issues, over utilization, under-utilization and suspected fraud based on clinical judgment. Reports results and recommendations for corrective action and/or quality improvement to the Quality Improvement Committee.
Participates in the implementation and design of the Utilization Management Program.
Participates as a member of the Quality Improvement Committee.
Participates as a member of the Utilization Management Committee.
Maintains responsibility for orientation and training of Clinical Reviewers.
Supervises staff of Clinical Reviewers and ensures consistency in application of all clinical decision-making.
Evaluates staff training methods and re-trains as needed.
Communicates Utilization Management (UM) guidelines, clinical review rationale, and participates in resolution of UM issues with staff, practitioners, and members.
Licensed as a dentist under the laws of the State of New York, authorized to practice dentistry without restriction and currently approved by the Department of Education of the State of New York or;
Licensed as a dentist under the laws of the State of New Jersey, authorized to practice dentistry without restriction and currently approved by the Department of Law & Public Safety, Division of Consumer Affairs of the State of New Jersey.Must have no history of any Medicaid/Medicare and/or other governmental regulatory sanctions.
Must be properly credentialed by a Credentials Verification Organization.
Maintain a knowledge of current dental procedures, terminology and treatment codes.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

Doctorate degree in the field of dentistry from an accredited dental school.Minimum of ten (10) years experience in the dental field.

Computer Skills:

Other Skills:

Proven leadership ability. Excellent verbal and written communication skills. Demonstrates expertise in a variety of the field's concepts, practices, and procedures. Relies on extensive experience and judgment to plan and accomplish goals.

Apply Now

Purchasing Assistant

Position Title:

Purchasing Assistant

Reports To:

Purchasing Manager

FLSA Status:

Non-Exempt

Summary:

Responsible for day to day purchasing tasks as specified below.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Generates and tracks Purchase Orders as directed by Purchasing Manager.
Assists with all aspects of Contract Administration, including disaster recovery manuals.
Assists with invoice reconciliation.
Compile comparative pricing for review as needed.
Maintain integrity of inventory Purchase Order records (ie. Basement inventory, item change forms).
Responsible for ensuring that all documents are saved in the appropriate file archives.
Perform other general administrative duties in support of the Purchasing Department as assigned.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

A.S. degree from four-year college and/or 1+ years experience in purchasing and inventory management.

Computer Skills:

Knowledge of Outlook Contact Management systems; and proficiency in Microsoft Software programs - Word, Excel, Access and Outlook. A working knowledge of Navision or other inventory management/purchasing systems is a plus.

Other Skills:

Strong attention to detail. Must have ability to multi-task and learn quickly.

Apply Now

Report Analyst

Position Title:

Report Analyst

Reports To:

Technical Lead, Reporting Services

FLSA Status:

Exempt

Summary:

A Report Analyst determines report requirements, identifies target data, builds/maintains appropriate data model, establishes/maintains data transformations, creates/modifies required queries, creates/modifies report presentation, verifies report accuracy, delivers the finished report, documents report process and maintains the reporting schedule.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Develop customized dashboards and create custom reports.
OBIEE repository development and SQL and PL/SQL development which includes but not confined to Procedures, Packages, and Triggers.
Collaborates with end users to identify needs and opportunities for improved data management and delivery.
Designs and builds Queries, Reports, and Dashboards using established frameworks and standards.
Architect, develop and validate critical financial report data (earned premium, check/batch printing); assist in the development of project timelines and documentation
Develop Oracle Business Intelligence Enterprise Edition (OBIEE) Reports and Dashboards, Business Objects,or any multidimensional enterprise reporting application.
Devise and implement document generation solutions (paper, electronic, e-delivery)
Thorough understanding of database structure and dimensional data models required.
Interfaces with customers through the life cycle of the report request.
Documents report fabrication procedures for quality assurance.
Revises report queries for optimal performance.
Implements safeguards to validate accuracy of report results.
Recommends establishment of new or modified reporting methods and procedures to improve report content and completeness of information.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

Employer will accept Bachelor's degree in Computer Science, Engineering, Business or related field, followed by five years of progressive, post-baccalaureate work experience in job offered or five years of progressive, post-baccalaureate work experience in a related occupation. Experience must include 5 years of experience with the following: Oracle PL/SQL; ETL; Data Modeling; Data Warehouse/Data Mart; Microsoft Access; and Excel.

Computer Skills:

Oracle Ingenix and GeoAccess/GeoNetwork, Oracle PL/SQL, ETL, Data Modeling, Data Warehouse/Data Mart, Microsoft Access, Excel. OBIEE a strong plus.

Other Skills:

Highly motivated and seeks out opportunities to improve existing processes. Demonstrates expertise in a variety of the field's concepts, practices, and procedures. Superior organizational skills, attention to detail, and ability to prioritize and manage multiple tasks. Knowledge of dental billing/claims, managed health care, health insurance claims a strong plus.

Apply Now

Web Application Developer- Entry Level

Position Title:

Web Application Developer- Entry Level

Reports To:

Manager of Application Development

FLSA Status:

Exempt

Summary:

A Web Application Developer designs critical components of internal and external web applications to achieve project goals and deliverables. Individual must be extremely well-rounded with respect to database, back-end and front end abilities (?full stack?). Duties also include testing, debugging and application support.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Designs and writes codes to support existing applications.
Develop strategies for unit and functional testing.
Develops appropriate solutions for system defects and minor enhancements.
Designs/develops/implements forward thinking technical solutions that meet requested need as well as facilitate future enhancements.
Implement vendor supplied applications and design/develop interfaces from internal systems to interact with accordingly.
Provides technical recommendations to help with solving business problems.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

Demonstrates expertise in a variety of the field's concepts, practices, and procedures. Relies on extensive experience and judgment to plan and accomplish goals. Be able to perform a variety of tasks. May provide consultation on complex projects and is considered to be the top level contributor/specialist. A wide degree of creativity and latitude is expected.

Computer Skills:

Demonstrates expertise in a variety of the field's concepts, practices, and procedures. Relies on extensive experience and judgment to plan and accomplish goals. Be able to perform a variety of tasks. May provide consultation on complex projects and is considered to be the top level contributor/specialist. A wide degree of creativity and latitude is expected.

Other Skills:

Strong knowledge of Web Applications, J2EE and Java development environments required.Ability to develop UI solutions using current web technologies (using HTML5, CSS and UI frameworks). Oracle 11g/12c with working knowledge of PL/SQL or a major RDBMS. Tomcat, Oracle Application Server or WebLogic Application Server experience preferred. Working knowledge of Open Source Projects (Spring, Pentaho, SVN). Strong communication and interpersonal skills. Highly Motivated/Self-Starter

Apply Now

Equal Employment Opportunity:

Healthplex is committed to equal employment opportunities. It is Healthplex's policy to prohibit employment discrimination, including but not limited to harassment on the basis of age, ancestry, color, marital status, (including civil union status), national origin, race, religious creed, sex, sexual orientation, disability, veteran status, citizenship status or any other characteristic protected by law.