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.

Apply Now

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

Care Coordinator

Position Title:

Care Coordinator

Reports To:

Manager of Operations

FLSA Status:

Non-Exempt

Summary:

The Care Coordinator is a liaison between the provider office and health plan to coordinate dental treatment requests in the operating room.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Process incoming Hospital Authorization cases within a timely manner. Including but not limited to: o Initiating contact with the health plan
o Routing cases to the health plan and communicate via phone, fax or e-mail
o Monitor case response timeframes
o Document all interactions in database
o Route dental claim forms to the appropriate teams internally
Assist Quality Coordinator with special projects and care management cases.
Support the Operations Team with various administrative tasks as needed. Including contacting members and/or provider offices.
Elevate appropriate issues to Manager.

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 1-4 years related experience and/or training; or equivalent combination of education and experience.

Computer Skills:

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

Other Skills:

Strong multitasking and organizational skills and adaptable to regular change. Strong written and verbal communication skills.

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

Complaint Coordinator

Position Title:

Complaint Coordinator

Reports To:

Director of Operations

FLSA Status:

Non - Exempt

Summary:

A Complaint Coordinator investigates and resolves member complaints for Healthplex and client groups.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Register and respond to all incoming complaint cases (verbal or written).
Provide written acknowledgement of all member and provider correspondence as it relates to member complaints.
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 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 the Oracle database 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.
Routinely maintain files, scan and file cases.
Handle any inbound and outbound communication with respect to complaints from members, providers and/or groups.
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 55 words per minute.

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.

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

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

Supervisor Office Administration

Position Title:

Supervisor Office Administration

Reports To:

Manager of Operations

FLSA Status:

Exempt

Summary:

Office Administration Supervisor oversees the daily functioning of the OA Department. The OA team?s tasks include a variety of time sensitive workflows. The Supervisor is responsible for organizing the daily workflow to ensure the team understands their duties and timeliness associated with their tasks.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.
Monitor and report the status of all OA workflow daily. Including but not limited to: mail sorting, opening, document sorting, batch preparing, e-mail preparation, scanning, stamping and delivery of documents.
Identify production issues, troubleshoot and discuss plan of action with Manager.
Forecast the impact of workflow voids and create a plan for resolution.
Document and update department policies and procedures.
Interview candidates for open positions within the OA Department.
Provide suggestions for implementing solutions to promote quality improvement within the OA Department.
Monitor behavior and performance of staff to ensure OA and Company policies are adhered to.
Communicate, review and demonstrate department changes with staff ensuring comprehension.
Oversee employee productivity and provide constructive feedback and coaching.
Prepare and deliver performance reviews and corrective action plans when needed.
Monitor all storage cabinets to ensure organization and appropriate shredding time frames are met.
Manage staff timecards, absences and requests for time off.
Perform and track associate audits.
Support and communicate operational goals set by Manager.
Contribute to team effort by accomplishing related results as needed.
Support Manager of Operations with tasks and special projects as needed.

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. 1-3 years of leadership experience.

Computer Skills:

Proficient in basic computer navigation skills. Basic knowledge of Excel and Microsoft Office.

Other Skills:

Strong attention to detail, problem solving and organizational skills. Foster teamwork, excellent communication and interpersonal skills.

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.