Job Description:
• Investigate and resolve provider claim issues for timely and accurate adjudication
• Submit demographic changes and updates to maintain accurate provider records
• Handle PPO complaints, grievances and appeals, including contract generation and amendments
• Manage provider network opt-in and opt-out participation requests
• Facilitate credentialing requests and compliance with organizational and regulatory standards
• Collaborate with the Department of Insurance and Special Investigations Unit on compliance and fraud prevention
• Provide guidance and training to dental providers on policies, procedures and portal navigation
• Send EFT, ERA and VCC enrollment requests for processing
• Interact directly with dental providers and internal teams to support network participation, provider data accuracy, claims resolution, credentialing and contracting
Requirements:
• Bachelor’s degree in dental, healthcare administration, business, or related field, or equivalent experience
• 5+ years of experience in dental, provider relations, network management, or healthcare operations/administration
• Strong understanding of PPO networks, credentialing processes and claims administration
• Excellent communication and problem-solving skills
• Proficiency in MS Office and provider management systems
• Detail-oriented with strong organizational skills
• Ability to manage multiple priorities in a fast-paced environment
• Knowledge of regulatory requirements and compliance standards
• Customer-focused commitment to service excellence
• Preferred: experience in the dental field and knowledge of PPO and Medicare networks
Benefits:
• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting physical, emotional, and financial well-being
• CVS Health bonus, commission or short-term incentive program eligibility