Dental Quality Operations Specialist

Health Resources•Evansville, IN

4d•Onsite

About The Position

The Dental Quality Operations Specialist supports the operation, quality, and compliance functions of the dental plan by coordinating activities across multiple teams and ensuring adherence to industry standards and regulatory requirements.

Requirements

Associates in business, management or healthcare administration or related field.
Strong analytical skills for reviewing data and identifying trends.
Able to solve complex problems using sound reasoning.
Exceptional writing skills for creating clear reports and professional communication.
Understands the importance of professionalism, especially when working with outside companies.
Skilled in Microsoft Office programs including Excel, Word, PowerPoint, Access, SharePoint, Salesforce, and Microsoft Project.
Able to draft reports and communicate effectively by phone, in writing, and in person.
Able to organize and manage multiple tasks independently.
1-2 years of experience working in the dental or health insurance industry.

Nice To Haves

Bachelors in business, management or healthcare administration or related field.
3-5 years of experience in a dental or health plan environment, with direct involvement in areas such as claims administration, enrollment processes, call center operations or similar high-level functions.

Responsibilities

Acts as the main contact for member and provider grievances, appeals, and complaints—handling intake, acknowledgement, investigation, coordination with internal departments and Health Plan Partner, and issuing timely responses per policies and regulations.
Supports the Quality Management (QM) program and facilitates the QM Committee, following the direction of the Dental Plan Operations Manager; responsible for establishing annual initiatives with the committee, coordinating resources, and ensuring key projects and priorities progress throughout the year.
Works under the direction of the Dental Plan Operations Manager to address operational needs across departments, including support for enrollment, call center activities, and claims payment processes.