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

Associate, Grievances and Appeals

Position Title:

Associate, Grievances and Appeals

Reports To:

Director of Operations

FLSA Status:

Non-Exempt

Summary:

A Grievances and Appeals Associate investigates and resolves member complaints, appeals, grievances and fair hearings for Healthplex and client groups. Provide administrative support to Director of Operations.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Provide written acknowledgement of all member and provider correspondence as it relates to member complaints, appeals and hearings.
Conduct thorough investigations of all member and provider correspondence by analyzing all the issues involved and obtaining responses and information from internal and external entities.
Interface with Healthplex internal departments, clients, and network providers to ensure resolution of case issues in a timely manner.
Compose correspondence related to processing of complaint, appeal and fair hearing cases including preparing correspondence to members, providers and clients, faxing and mailing correspondence, copying correspondence and supporting documents and creating a case file.
Enter notes in Oracle and MS Access as they relate to the initial investigation and resolution of the case.
Monitor pending case files and make necessary follow-up calls to internal and external entities to ensure that cases are completed on or before the applicable timeframe.
Document all actions taken in investigation for auditing and reporting purposes.
Prepare cases for review ensuring that all pertinent information (i.e. correspondence, internal and external responses, diagnosis, radiographs, dental chart) have been obtained during investigation as is present as part of the case.
Open and distribute incoming mail daily.
Maintain files, scan and file cases on a weekly basis by client.
Answer incoming calls and assist caller when applicable.
Contact members and clients by telephone in order to investigate and resolve issues.
Other functions and projects may be assigned as business conditions change.

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. Legal or dental background a strong plus.

Computer Skills:

Proficient in Microsoft Office programs and ability to type 55wpm.

Other Skills:

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

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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

Business Development Coordinator

Position Title:

Business Development Coordinator

Reports To:

Director of Business Development

FLSA Status:

Non-Exempt

Summary:

The Business Development Coordinator will support the strategic sales plan, and assist in coordinating efforts in the marketplace and internally to help reach sales and revenue goals.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Work with Director of Business Development to support in the development and execution of comprehensive strategic plans to support sales and revenue objectives.
Supervise and support the Business Development Team by interfacing with department heads to coordinate and gather information or relevant materials needed for completion of a proposal.
Interface and assist the Implementation Team to assist in setting up new groups.
Rate commercial dental plans based on guidelines filed with NYS.
Review and analyze plan materials/RFPs received from brokers/clients.
Create commercial proposals for prospective clients.
Prepares reports and analysis for departmental and management decision-making using MSOffice and other reporting tools as necessary to examine sales.
Authors marketing materials and other collateral in support of strategic plan and product launches.
Contributes to the improvement and development of instructions and training materials.

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, plus two years related experience or equivalent combination of education and experience.

Computer Skills:

Proficient in Microsoft Office and Salesforce.

Other Skills:

Must have ability to multi-task, prioritize projects and the flexibility to work within tight deadlines. Strong attention to detail and demonstrates excellent verbal and written communication skills. Must have ability to work under minimal supervision and learn quickly.

Apply Now

Claims Processor

Position Title:

Claims Processor

Reports To:

Claims Manager

FLSA Status:

Full Time

Summary:

A dental Claims Representative 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 separate 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 eligibility, 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 one year minimum related dental assisting and/or insurance billing experience and/or training; or equivalent combination of education and experience. Dental office experience strongly preferred.

Computer Skills:

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

Other Skills:

Knowledge of ADA codes, dental procedures and terminology. 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

Clinical Reviewer (Licensed Dentist)

Position Title:

Clinical Reviewer (Licensed Dentist)

Reports To:

Director of Utilization Management

FLSA Status:

Non-Exempt, Part-Time

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 and 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.

Qualifications:

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.

Education And/Or Experience:

Be a graduate of an accredited dental school.
Have a minimum of ten (10) years experience in the dental field.

Computer Skills:

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.

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.

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.

Apply Now

Outreach Representative

Position Title:

Outreach Representative

Reports To:

Supervisor of Outreach & Education

FLSA Status:

Non-Exempt, Part-Time, Temporary

Summary:

An Outreach Representative works directly with members and provider offices to increase utilization and access/availability of services to members. An Outreach Representative must be able to speak in English as well as one of the following: Spanish, Mandarin, Cantonese, Russian, Bengali or Urdu. SCHEDULE: Monday - Friday 12:00pm - 6:00pm Assignment starts May 6, 2019 - December 13, 2019

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Reach out to members by phone and encourage them to utilize their coverage.
Educate members on their dental benefits and provide members with assistance scheduling an appointment with a Healthplex dental office.
Track and document member Appointments.
Call members to confirm dental appointments.

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 with (1-2) years of Customer Service Call Center experience preferred. Excellent verbal and written communication skills. Bilingual Spanish and Cantonese a plus.

Computer Skills:

Basic computer and keyboarding skills.

Other Skills:

Knowledge of dental procedures and terminology a strong plus. Excellent communication skills. Good voice and diction. Bi-lingual English, Spanish, Mandarin, Cantonese, Russian, Bengali or Urdu. Excellent customer service skills (friendly, courteous and helpful).

Apply Now

Sales Support

Position Title:

Sales Support

Reports To:

VP Business Development and Client Relations

FLSA Status:

Non-Exempt

Summary:

A Sales Support handles inbound calls related to plan inquires for the Sales department.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Take inbound calls for inquiries on Healthplex dental plans and convert to sales, new members.
Walk new customer through the enrollment process by gathering their personal information and inputting into database.
Process credit card payment for new members. Ensure information is secure and confidential.
Educate current members on the value of their plan to ensure annual renewal.
Provide a positive experience to all callers regardless if interaction translated to an enrollment / sale.
Properly escalate calls from groups, GA?s and Brokers to Account Services or Sales.
Provide administrative support in a variety of capacities, including, printing, copier projects, mail handling, supplies control, processing of letters/correspondence.

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 plus 2-4 years related experience and/or training; or equivalent combination of education and experience.

Computer Skills:

Basic computer Salesforce a plus. Ability to type at least 35 wpm.

Other Skills:

Excellent verbal and written communication skills, good grammar, voice and diction. Excellent customer service skills (friendly, courteous and helpful). Bilingual capabilities preferred but not required unless specified. NYS Life and Health License a strong plus.

Apply Now

Sales Support Representative - Inbound Calls

Position Title:

Sales Support Representative - Inbound Calls

Reports To:

VP Business Development and Client Relations

FLSA Status:

Non Exempt

Summary:

A Sales Support Representative handles inbound calls related to plan inquires for the Sales department.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Take inbound calls for inquiries on Healthplex dental plans and convert to sales, new members.
Walk new customer through the enrollment process by gathering their personal information and inputting into database.
Process credit card payment for new members. Ensure information is secure and confidential.
Educate current members on the value of their plan to ensure annual renewal.
Provide a positive experience to all callers regardless if interaction translated to an enrollment / sale.
Properly escalate calls from groups, GA's and Brokers to Account Services or Sales.
Provide administrative support in a variety of capacities, including, printing, copier projects, mail handling, supplies control, processing of letters/correspondence.

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 plus 2-4 years related experience and/or training; or equivalent combination of education and experience.

Computer Skills:

Basic computer Salesforce a plus. Ability to type at least 35 wpm.

Other Skills:

Ability to persuade and influence others. Ability to develop and deliver presentations. Ability to create, compose, and edit written materials. Strong interpersonal and communication skills. Knowledge of advertising and sales promotion techniques. Visibility requires significant local travel to current and potential clients. This requires the possession of a valid state drivers' license. NYS Life & Health License a strong plus.

Apply Now

Trainer

Position Title:

Trainer

Reports To:

Director of Customer Service

FLSA Status:

Exempt

Summary:

The Customer Service Trainer is responsible for training the customer service staff. This position is responsible for the design and implementation of all Customer Service Department training programs, research of new training techniques and proposition of enhancements to existing customer service processes and training programs.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Develop and maintain customer service training manual, to include soft skills, technical skills and plan guidelines.
Deliver customer service training to staff.

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:

Computer Skills:

Other Skills:

Apply Now

Training and Development Supervisor

Position Title:

Training and Development Supervisor

Reports To:

Director, Customer Service

FLSA Status:

Exempt

Summary:

The Training and Development Supervisor is responsible for the training and professional development of the customer service staff. This position is responsible for the design and implementation of all Customer Service Department training programs, research of new training techniques and proposition of enhancements to existing customer service processes and training programs. The Training and Development Supervisor is also responsible for the coaching, supervision and professional development of Team Lead and SLS staff members.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Develop and maintain customer service training manual, to include soft skills, technical skills and plan guidelines.
Deliver customer service training to staff.
Conduct new hire orientation.
Obtain MAGIC Certification and partner with company MAGIC facilitator to facilitate MAGIC trainings for new hires as well as engage in MAGIC refresher trainings. Propose skill measurement and feedback processes to ensure call quality standards that exceed customer expectations.
Support the process of coaching staff in meeting the department?s quality and productivity goals.
Work as a liaison with other departments (i.e. Enrollment, Claims) to determine correct procedures /responses to customer service inquires. Compile these responses to be delivered to customer service staff as part of an ongoing training platform.
Work with system development on system enhancements to help gain overall efficiency.
Work with IA department to identify areas of staff deficiencies through QA program and develop training to correct staff inadequacies.
With the assistance of the Director, Supervisor and Leads develop workflow plans to anticipate trends in the department as it relates to productivity, employee performance/behavior and respond and/or elevate accordingly.
Support the department with strategic goals and development.
Work as a backup to the Issue Resolution function.

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:

Associates degree in a related area plus 3-5 years of relevant work experience. Knowledge of a variety of concepts, practices, and procedures commonly used within the field. MAGIC certification.

Computer Skills:

Strong MS Word, Excel and Power Point. Familiar with Oracle-based database system.

Other Skills:

Excellent written and verbal communication skills. Good grammar, voice and diction. Excellent presentation skills. Ability to effectively communicate to large audiences. Management and supervisory skills. Excellent customer service skills (friendly, courteous and helpful) accurate record-keeping skills, strong ability to prioritize tasks, strong conflict resolution skills. Ability to motivate and influence others in achieving departmental 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.

Reasonable Accommodation of Individuals with Disabilities

It is the policy of Healthplex, Inc. to provide reasonable accommodations for qualified persons with disabilities. If you need assistance or accommodations for any part of the employment process, due to a disability, please contact the Human Resources Department at 516-542-2662 to be directed accordingly.