Provider Relations QA Specialist

Job Posting

For more than 45 years, Careington International has been a leader in the health and wellness benefits space. Since its founding in 1979, Careington has been delivering dental discount solutions as its core competency. Today, Careington has expanded to offer a growing portfolio of 150+ health, wellness, lifestyle and virtual health products and services designed to deliver cost savings across a spectrum of life needs. Through its affiliated nationally licensed third-party administrator (TPA), Careington also delivers full-scale administrative services, including customer service, licensed enrollment, claims administration, individual and group billing, and more.

We are based in Frisco, TX. If you are looking for a great company culture filled with rewarding career advancement opportunities, this is the place for you.

Key Responsibilities

• Serve as a dedicated liaison for clients and provider offices, ensuring consistent communication and support.
• Answer incoming calls from provider offices in a timely and professional manner while delivering excellent customer service.
• Operating in a deadline driven environment requiring timely resolution of provider and client inquiries.
• Manage and respond to a large-scale of email inquiries from provider offices and clients, along with providing accurate information and timely follow-ups.
• Educate dental offices on plan administration, policies, and participation requirements via phone and email.
• Contact dental offices to research and gather information regarding member billing concerns and quality-of-care grievances.
• Conduct audits of dental offices to ensure compliance with participation requirements and plan administration guidelines.
• Maintain detailed and accurate documentation of all communications and case activity within internal systems.
• Balance a large volume of tasks, ensuring consistent tracking and follow-up with provider offices, internal teams, and clients.
• Maintain a high level of professionalism, organization, and customer service in all interactions.

Skills & Competencies

• Demonstrate advanced problem-solving and analytical thinking skills with the ability to make independent decisions.
• Maintain a high level of professionalism, organization, and customer service in all interactions.
• Possess excellent conflict resolution and de-escalation skills.
• Exhibit efficient time management and multitasking in a fast-paced environment
• Communicate effectively through both written and verbal communication.
• Apply professional phone etiquette and active listening skills with empathy.
• Retain and apply policies and procedures to address provider and member inquiries.
• Ability to handle sensitive information with discretion and professionalism.

Qualifications

• Experience within a call center software queue environment is highly preferred.
• Background in dental or medical administrative work is considered a plus for this role.
• Maintain proficiency in Microsoft Office Suite (Word, Excel, Outlook, Adobe, Microsoft Teams).
• A college degree is preferred, but equivalent work experience will be considered.

Equal Opportunity Employer 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.