Eligibility Representative

Do you excel at solving problems, providing excellent customer service, and ensuring accuracy in a fast-paced environment? As an Eligibility Representative, you'll be responsible for setting up new groups eligibility, maintaining accurate eligibility records for premium reconciliation, and researching answers to client and internal inquiries. You’ll work collaboratively with a dedicated team to improve processes, ensure premium reconciliation accuracy, and provide timely support. We’re looking for an organized, professional individual with a customer service mindset and problem-solving skills to join our team.

At Delta Dental of Washington our vision is that all people can enjoy good oral and overall health, with no one left behind. We succeed because of a shared commitment to a set of values that guide everything we do – for our customers, for our communities, and for each other. We are Accountable. We lean in with Courage. We stay Curious. We are Inclusive. We act with Integrity.

We offer a highly competitive medical, dental and vision plans as well offering a generous 401k match and all employees start accruing vacation and sick time from their very first day. We empower employee development through our tuition reimbursement plan, professional development plans, and employee-led communities.

The pay range for this position in Western Washington varies between $39,520.00 – $49,650.00, and for Eastern Washington varies between $40,560.00 - $48,575.00. Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza Corp. intends to offer the selected candidate a base pay within this range, dependent on job-related, non-discriminatory factors such as experience. Base pay will also be adjusted based on the candidate's geographic location.

Essential Responsibilities include the following: The list of responsibilities listed is not intended to be comprehensive. Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza reserve the right to change the responsibilities at any time with or without notice.

• Research and provide accurate responses to internal and external inquiries regarding eligibility via telephone and written correspondence.
• Process Dental and Vision eligibility updates for Billing and Online Groups through data entry.
• Review correspondence and process enrollments and updates assigned via the HealthLogic website.
• Verify/confirm eligibility for members with vision benefits using the VSP Portal.
• Create call tracking for claims reprocessing, history transfers, or updating incentive levels.
• Educate group representatives on eligibility requirements.
• Attend site visits for Groups, Brokers, and Third-Party Administrators.
• Develop and maintain positive relationships with Groups, Brokers, and Third-Party Administrators.
• Support the identification of problem areas and propose effective solutions as needed.

Experience, skills, and education do you need to have to succeed in the position: The requirements listed below are representative of the knowledge, skill, and/or ability required to successfully perform the essential functions of the position.

• Excellent verbal and written communication skills, with the ability to craft professional, client-appropriate correspondence.
• Strong computer proficiency, with exceptional speed and accuracy in data entry.
• Strong attention to detail with consistent follow-up and a focus on customer service
• Well-organized and dependable, with the ability to manage deadlines and shifting priorities
• Self-motivated with a strong desire to learn, grow, and perform at a high level
• Demonstrates a positive, professional attitude and an open-minded approach during meetings and training sessions.
• At least one year of experience in insurance eligibility, billing, or accounts receivable preferred.
• High school diploma or GED required.

Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

We are committed to the highest standards of information security and HIPAA compliance, ensuring the confidentiality, integrity, and protection of all data. All staff are expected to support this commitment by following relevant policies.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.