This job oversees the daily activities, including workforce and inventory management, for Outside the Continental United States (OCONUS) claims/adjustment processing, foreign check stop pay/reissue, telephone customer service and responding to written routine, priority (Congressional/Department of Defense), and appeal inquiries. Responsible for staff direction, coaching, mentoring, and to provide technical assistance. Assists to interview new candidates with foreign language skills, and provides initial and ongoing OCONUS training due to the complex processing and translations required. Position is the point of contact for Government lead personnel in foreign offices, as well as for top OCONUS preferred dentists. Position maintains a strong collaboration with the Government personnel to readily address OCONUS issues and also assists to work with foreign providers to retain and expand the network preferred provider overseas network. Responsibilities also include assisting with translations, verifying foreign exchange payment accuracy and working with the bank to reconcile data and transaction reports. Provides testing support and assists with Government and internal audits.
- Supervises staff who perform foreign claims/adjustment processing, foreign check stop pay, reissues, customer service telephone support and written routine, priority (Congressional / Department of Defense), and appeals inquiries, as well as assist to prepare case files for grievance inquiries. Provides workforce and inventory management oversight to ensure all claims and customer service (phone/written) performance standards are consistently met.
- Performs quality control for all OCONUS functions. Provides iniital and ongoing OCONUS training due to the complexity of the processes and the language translations required. Assists to interview and hire staff with foreign language proficiency.
- Develops and maintains OCONUS operational policies and procedures. Functions as the lead for system changes that impact foreign claims processing. Assists with systems testing of OCONUS claims, adjustment, and inquiries, including business disaster recovery testing. Also, provides Government and internal OCONUS audit support.
- Assists with the majority of the foreign claims translations, which are German claims. Is staff does not have the language skills needed, a language translation service is utilized.
- Functions as the point of contact for oversees Government personnel to address unique OCONUS issues and concerns. Also, works collaboratively with the Government to build strong relationships with oversees providers to retain and expand the preferred provider overseas network.
- Verifies the accuracy of Government and internal OCONUS reports. Also, assists to provide bank data and report reconciliation for each check cycle.
- Other duties as assigned or requested.
High School Diploma/GED
- 1 - 3 years' experience supervising or leading staff in a fast-paced production environment, preferably in dental health care
- Knowledgeable in dental policy with a detailed understanding of Government OCONUS contract requirements, policies and procedures, and reports
- Experience utilizing workforce and inventory management tools and reports to effectively manage daily activity to ensure all contract timeliness and accuracy standards are met
- Knowledgeable in UCCI systems, including claims, adjustments, and telephone and written inquiry systems
- Competent in claims and customer service processes and procedures to effectively perform quality control of all functions
- Experience in providing initial and reinforcement on-going training
- Competent to draft documents, such as training materials, policies and procedures, business specifications, and reports
Employees supporting the TDP and/or ADDP contract must complete a Government background questionnaire, verification process, credit check and attain a favorable trustworthiness determination as required by the Department of Defense (DoD) contract. In addition, the DoD requires incumbents to be citizens of the United States of America.
- Proficient in foreign languages, particularly German
- Experience working collaboratively with Government personnel and other internal support staff
- Experienced working directly with providers and members fluent in a foreign language
- Supervisory and systems testing experience
- Ability to talk to foreign providers about becoming an overseas network provider and/or to attain claims information needed to process initial or adjustment claims
KNOWLEDGE, SKILLS & ABILITIES
- Excellent personnel management skills; able to effectively hire, train, and coach employees, some of whom are proficient speaking a foreign language and English is their second language
- Workforce and inventory management skills to ensure work is evenly distributed, and montored to ensure that all contract timeliness requirements are met
- Able to perform quality control review of OCONUS dental claims and customer service functions to ensure that all processes are completed with accuracy, completeness and professionalism
- Knowledgeable in dental policy; able to apply policy to process claims and inquiries, as well as to draft operational policies and procedures
- Professional demeanor; able to collaborate effectively with high level Government personnel
- Excellent listening, verbal and written communication skills
- Attention to detail; competent to verify the completeness and accuracy of Government and internal reporting data prior to report release
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
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