Customer Service Associate

Job Summary A Customer Service Agent following established company guidelines resolves customer issues received by telephone, mail or fax from group administrators, subscribers and dentists. An Agent explains Delta Dental 's group contracts, agreements, processing policies and procedures. An Agent can also adjudicate dental claims and resolve adjustments. Job Summary A Customer Service Agent following established company guidelines resolves customer issues received by telephone, mail or fax from group administrators, subscribers and dentists. An Agent explains Delta Dental 's group contracts, agreements, processing policies and procedures. An Agent can also adjudicate dental claims and resolve adjustments. Before You Apply To help you determine whether this opportunity is a match for you, please note the following: This is a hybrid role with required onsite attendance in our Parsippany, NJ office every Tuesday and Wednesday. The working hours for this position are 10:00 a.m. to 6:30 p.m. Monday through Thursday and 9:00 a.m. to 5:00 p.m. on Fridays. Your first six weeks will be dedicated to onboarding and training, which will be conducted remotely Mon, Thurs, Friday and on site Tues/Wed. The training schedule will be provided before your first day. This position is expected to begin on October 12, 2026. Essential Functions & Responsibilities Adhering to the Agent’s schedule, the Agent is required to be available on the call center ACD to answer customer calls while meeting and exceeding department KPI’s. As a team member, researches and resolves inquiries and responds to customers with an appropriate and accurate written or verbal notification. Calculates adjustments and creates and processes claims for adjusted payments. Creates and processes standard claims, claims with coordination of benefits, pre-treatment estimates, and pretreatment estimates with dated services. Maintains and updates subscriber files with information obtained through inquiries and submitted claims and documents, i.e., individual and family on hold codes, applied or removed. Performs all tasks necessary to resolve all questions based on Delta Dental’s claims processing guidelines and Dentist handbook, as well as Delta Dental’s website and mobile application. Documents each inbound call in call tracking, follow up, or any pended requests. Generates check research requests for outstanding payments. Understands all claim guidelines and effectively uses this information to resolve related inquiries. Researches and resolves requests from other departments such as Marketing and Enrollment. When necessary, refers claims or subscriber eligibility to Management or other departments such as Professional Services, Claims, Marketing and Enrollment. Supports and participates as needed for inventory reduction tasks such as correspondence and/or call tracking. Other duties as assigned Essential Qualifications Competencies Adaptability/Flexibility Communication Computer Skills Customer Focus Dependability Job Knowledge Productivity Quality Teamwork Knowledge, Skills & Abilities KPI’s Adherence standard is 96% After call work time – 10 seconds Quality: 99% Technical and Functional Ability to regard customer service excellence as a priority Personal computer skills with knowledge of MS applications such as Windows, Word and Excel and browser based applications such as Internet Explorer Excellent communication and listening skills Excellent math aptitude Creativity and flexibility when solving problems Ability to work in an environment where work is carefully monitored for accuracy Required Physical Abilities The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ability to sit and perform extensive close keyboard and PC work including data entry Ability to walk, talk or hear Occasionally required to stand and reach with hands and arms Working Environment Ability to meet attendance standards. Must be able to sit/stand, talk and hear. The noise level in the work environment is usually moderate. This classification will be required to sign a confidentiality agreement. Experience Required Experience, Education and Certifications Required 1-3 years customer service/call center experience Dental Assistant education/experience is a plus Required Educational Level Requires high school diploma or equivalent. Other Certification n/a In addition to salary, Delta Dental of New Jersey’s offerings may also include, for eligible employees, discretionary and formulaic incentive awards. Available offerings may vary by geographic location, job level, skills, experience, qualifications, education and date of hire. New Jersey Pay Range: $25.26 USD - $25.26 USD About Delta Dental Of New Jersey & Connecticut Delta Dental of New Jersey, Inc. is New Jersey's leading dental benefits company, providing or administering coverage to more than 2.2 million people through contracts with groups and individuals in New Jersey and Connecticut. In Connecticut, Delta Dental of Connecticut, Inc. is a licensed insurer that writes dental and vision coverage on an insured basis, and Delta Dental of New Jersey administers self-funded dental benefit programs. Offering dental benefits since 1969, Delta Dental of New Jersey's mission is to promote oral health to the greatest number of people by providing accessible dental benefit programs of the highest quality, service, and value. Through its philanthropic arm, the Delta Dental of New Jersey Foundation awards more than $1M in grants annually to support access to dental care and education for underserved children, seniors, veterans, and those with special needs, as well as funds workforce development programs for dental assisting and dental hygiene across New Jersey and Connecticut. Benefits In addition to a great culture, we offer excellent benefits including medical, dental, vision, life insurance, short and long-term disability, spending accounts, and matching 401k. We value our associates and support everyone with learning and development, recognition programs, active wellness and diversity initiatives, tuition reimbursement, and generous paid time off to recharge – even paid time off to volunteer at causes that you care about. Delta Dental of New Jersey Inc is an equal opportunity employer All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, ancestry, sex, sexual orientation, gender identity, national origin, genetics, disability, marital status, age, veteran status, domestic partner status, medical condition or any other characteristic protected by law. #J-18808-Ljbffr Delta Dental of New Jersey and Connecticut