Issue Resolution Lead Analyst, Individual Dental Operations

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

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

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

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

• Assess customer needs and formulate effective resolutions utilizing technical knowledge and established processes.

• Convey findings, decisions, and resolutions to customers, business partners, and leadership.

• Ensure complete and accurate documentation of all cases.

• Monitor case activities and turnaround times to ensure regulatory and internal compliance.

• Identify and escalate compliance risks, missed dependencies, and barriers to resolution.

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

• Assist with audits, compliance reviews, and operational inquiries.

• Analyze issues and case activities to pinpoint recurring themes, trends, process gaps, and risks.

• Suggest improvements to customer service processes, workflows, controls, communications, and documentation.

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

• Offer technical guidance and subject matter expertise to team members and cross-functional partners.

• Coordinate timely resolutions with Operations, Compliance, Customer Service, and business support teams.

• Share insights on trends, risks, and lessons learned.

• Independently manage workload, competing priorities, and time-sensitive requests.

⛳️ Requirements

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

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

• Current experience in Individual & Family Plans (IFP), encompassing marketplace operations, regulatory requirements, and processes for resolving customer issues.

• Familiarity with federal exchange and state-based marketplace environments.

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

• Capacity to manage multiple priorities, adhere to tight deadlines, and adapt to evolving business needs.

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

• Ability to leverage technical knowledge, business processes, and available resources to ensure prompt and accurate resolutions.

• Excellent verbal and written communication skills.

• Proficient in Microsoft Office applications and internal systems used for IFP and Dental operations.

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

• Preferred: Experience with Senior Leadership escalations, Health Insurance Casework System issues, or Department of Insurance casework.

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

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

• Preferred: Background in providing technical guidance, peer support, or informal leadership within an operational team.

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

🏝️ Benefits

• Eligibility for an annual bonus plan.

• Medical insurance coverage.

• Vision insurance coverage.

• Dental insurance coverage.

• Programs for well-being and behavioral health.

• 401(k) retirement plan.

• Company-provided life insurance.

• Tuition reimbursement options.

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

• Paid holidays.

• Leaves of absence available.

• Opportunities for remote work (either occasionally or permanently, depending on internet requirements).