Issue Resolution Lead Analyst, Individual Dental Operations

This is a fully remote position, open to applicants in Missouri, +3 more states.

📋 Description

• Oversee the intake queues for assigned customer issues by tracking, prioritizing, researching, documenting, resolving, and closing cases.

• Investigate and resolve intricate or sensitive customer concerns, complaints, inquiries from Senior Leadership, and matters related to the Department of Insurance.

• Assist with inquiries received through federal exchange and state-based marketplace channels.

• Assess customer requirements, determine subsequent actions, and devise effective resolutions.

• Relay findings, decisions, and solutions to customers, business partners, and leadership.

• Ensure complete and precise documentation of all cases.

• Track case activities and turnaround times to ensure compliance with regulatory and internal standards.

• Recognize and escalate compliance risks, missed dependencies, or obstacles to prompt resolution.

• Implement requirements related to marketplace, dental products, and customer issue resolutions.

• Safeguard customer information while adhering to privacy, security, documentation, and records management protocols.

• Assist with audits, compliance reviews, and operational inquiries using case information and subject matter expertise.

• Analyze issues and case activities to uncover trends, process deficiencies, and emerging risks.

• Document findings and propose enhancements to processes, workflows, controls, communications, and documentation.

• Engage in operational projects, business testing, and initiatives aimed at process improvement.

• Offer frontline insights and subject matter expertise to enhance customer experience and operational efficiency.

• Validate changes in processes and ensure solutions meet business requirements.

• Provide technical guidance and share knowledge with team members.

• Collaborate with Operations, Compliance, Customer Service, and business support teams.

• Cultivate relationships with matrix partners.

• Communicate trends, risks, and lessons learned.

• Independently manage workload, prioritize competing demands, and handle time-sensitive requests.

⛳️ Requirements

• At least three years of experience in the healthcare insurance business, focusing on benefits, eligibility, claims, customer service, contact center operations, sales, or business operations.

• A minimum of two years of experience addressing complex inquiries for Stand-Alone Dental customers.

• Current familiarity with Individual and Family Plans (IFP), including marketplace operations, regulatory standards, and customer issue resolution processes.

• Understanding of federal exchange and state-based marketplace environments.

• Knowledge of customer issue research, case management, escalation processes, and documentation standards.

• Ability to handle multiple tasks, meet tight deadlines, and adapt to evolving business needs.

• Strong analytical, decision-making, and problem-solving abilities.

• Proficiency in leveraging technical knowledge, business processes, and available resources to ensure accurate and timely resolutions.

• Excellent verbal and written communication skills, including the ability to document complex findings clearly and professionally.

• Proficient in Microsoft Office applications and internal systems relevant to IFP and Dental operations.

• Willingness to work additional hours and modify planned time off during peak operational times.

• For remote work, a cable broadband or fiber optic internet connection with a minimum of 10 Mbps download and 5 Mbps upload speed is required.

• Preferred: experience with escalations to Senior Leadership, matters related to the Health Insurance Casework System, or Department of Insurance casework.

• Preferred: experience with IFP Dental products, systems, and processes, including Dentacom, Dentaque, OneView, and claim-processing guidelines.

• Preferred: experience in operational testing, trend analysis, process improvement, or business documentation.

• Preferred: experience providing technical guidance, peer support, or informal leadership.

🏝️ Benefits

• Medical, vision, and dental benefits available from day one.

• Well-being and behavioral health programs starting on day one.

• 401(k) plan.

• Company-paid life insurance.

• Tuition reimbursement program.

• A minimum of 18 days of paid time off each year.

• Paid holidays.

• Leaves of absence.

• Eligibility for an annual bonus plan.

• Remote work arrangement.