Provider Service Representative at Nagler Group

Overall Responsibility:  To deliver high quality client service to doctors or doctor’s office staff, members, community partners and plan sponsor representatives in a professional, respective and helpful manner. Process claims in a timely, accurate manner.

Key responsibilities and accountabilities:

• Respond to inbound telephone calls, faxes and emails from doctors or doctor’s office staff, and plan sponsor representatives in a timely and professional manner;
• Respond to inbound telephone calls, faxes and emails from members or member representatives in a timely and professional manner;
• Process dental claims on system for all clients;
• Process claim corrections from daily EDI reports;
• Document communications with doctors and doctor’s office staff, and plan sponsor/employer representatives;
• Document communications with members and member representatives;
• Respond to claim inquiries from subscribers, doctors and plan sponsor/employer representatives in a timely and professional manner;
• Respond to benefit coverage inquiries from members and member representatives in a timely and professional manner;
• Respond to eligibility inquiries from subscribers, doctors and plan sponsor/employer representatives in a timely and professional manner;
• Maintain department productivity and quality expectations;
• Maintain knowledge of dental plan designs, exclusions, limitations and exceptions for each client;
• Adhere to all process and procedural guidelines;
• Any other duties as assigned