Provider Relations QA Specialist

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.