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

Administrative Assistant Part-Time

Position Title:

Administrative Assistant Part-Time

Reports To:

President - Dentcare

FLSA Status:

Non-Exempt

Summary:

An Administrative Assistant provides administrative support to company executives and corporate legal department as assigned.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Create and format documents and templates.
Summarizes documents and contracts.
Edit and review documents proficiently.
Ability to meet multiple deadlines, and possess strong decision making and problem solving skills.
Must possess expert level of written and verbal communication skills.
Screen and answers telephone calls and forwards telephone messages to the President.
Perform special projects as assigned by the President, which require proficiency in MS word and Excel, as well as other MS Office Products.
Excellent organization and time management skills.
Prepare documents for New York Health Exchange.
Prepare and maintain Minutes and advertising books for Dentcare Delivery Systems, Inc.
Create Biographical Affidavits for new Board Members.

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:

Bachelor's degree from four-year college or university; and three to four years related experience and/or training specifically in the healthcare field; or equivalent combination of education and experience.

Computer Skills:

Microsoft Outlook, Excel and Word, ability to type at least 55 wpm.

Other Skills:

Demonstrated ability to handle multiple projects and details simultaneously in a fast paced client driven environment. Requires self-direction, tact, diplomacy and a clear, courteous and professional manner when dealing with the co-workers and public. Must demonstrate effective verbal communication skills and the ability to work cooperatively with staff and clients.

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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

Client Management Coordinator

Position Title:

Client Management Coordinator

Reports To:

Director of Operations

FLSA Status:

Exempt

Summary:

A Client Management Coordinator acts as the point person for health plans as it relates to oversight of regulatory and reporting requirements.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Manages all day-to-day operations for various Government MCOs.
Serves as liaison with clients and internal departments to help oversee and facilitate contract and regulatory requirements.
Responsible for all phases of implementation and new Government programs and expansions.
Attends client meetings to review contract renewal and plan utilization to ensure clients are satisfied with group benefit offerings and overall services.
Presents semi-annual quarterly reports to clients to showcase efforts in Outreach & Education that directly increase HEDIS/Non-HEDIS utilization.
Fulfills routine and ad-hoc reporting requests.
Oversees and satisfies all audit requests from DOH, DFS, CMS and independent agencies.
Assist the CEO/COO with special projects.

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:

Two year Associate degree and two to three years related experience and/or training specifically in the healthcare field; or equivalent combination of education and experience.

Computer Skills:

Strong proficiency with Microsoft Office programs, including Word, Excel, Outlook.

Other Skills:

Strong organizational skills. Strong verbal and written communication skills required. Client-focused professional with ability to communicate effectively to a variety of audiences.

Apply Now

Clinical Reviewer Orthodontist

Position Title:

Clinical Reviewer Orthodontist

Reports To:

Director of Utilization Management

FLSA Status:

Non-Exempt

Summary:

The primary function of the Clinical Reviewer is to review dental claim forms, treatment plans and other documents relating to the provision of dental services and impose, wherever applicable, the exclusions & limitations of the Companys' dental benefit plans.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Review documents submitted by managed care and fee-for-service dentists in the manner set forth in the Companys' policies.
Respond on a timely basis to inquiries from staff members regarding the provision of services to enrollees.
If requested, to participate as a member of the Quality Improvement Committee.
If requested, to participate as a member of the Utilization Review Committee.
If requested, to participate as a member of the Complaint and Appeals Review Committee.
Licensed as a dentist under the laws of the State of New York, authorized to practice dentistry 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 and currently approved by the Department of Law & Public Safety, Division of Consumer Affairs of the State of New Jersey.
Have no history of any Medicaid/Medicare and/or other governmental regulatory sanctions.
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:

Accredited Dental school graduate. Minimum of 10 years' experience in the dental field.

Computer Skills:

Microsoft Office Word, Excel Outlook.

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.

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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

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.