Claims Recovery Specialist
Claims Recovery Specialist
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Job Summary:
Manage the refund process; request and evaluate reports to identify outstanding refunds; process refunds and perform audits for the monthly corporate audit.
Primary Job Responsibilities:
- Adjudicate and process refund in accordance with benefit contracts and plan policies during the handling of overpayments which may include adjustments such as reverses standard adjustments and processing returned checks and reissues.
- Perform monthly corporate audit and provide reporting to Claims Manager and CAO. Recommend policy changes that will enable the refund process to run more efficiently.
- Assist customer service on overpayment adjustments and answer questions from providers and subscribers. Handle calls that are transferred from customer service regarding overpayments or any withholds that may have occurred along with check related issues.
- Perform mass reopens and load history to patient file and assist when needed.
- Collaborate with the Eligibility department when policies have termed with claims in history and when a subscribers personal information needs updating to have a check reissued. Review retro term list with possible claims paid after term date and process adjustments to generate overpayment letters and send out corrected Explanation of Benefits.
- Create help desk ticket to issue overpayment recovery letter when requested from the provider or subscriber in the event they have misplaced or never received the original letter. Handle requests for information regarding investigation of potential fraud cases.
- Handle subrogation claims and bankruptcies for subscribers or providers who owe Delta Dental money. Work directly with Finance department regarding outstanding claim checks and check related problems.
- Work with various other internal departments to identify and resolve claims and eligibility issues.
Minimum Qualifications:
Position requires a high school diploma or equivalent and three to five years of collections and/or audit experience. Previous work in dental insurance preferred. Will accept any suitable combination of education training or experience.
Position requires advanced math skills: PC keyboarding and proficiency with Microsoft Office products; advanced verbal and written communication skills; strong customer service skills; strong proficiency in evaluating and processing through to completion the refunds submitted via claim processing system in conjunction with production criteria; knowledge of dental terminology and dental insurance laws regulations and contracts is preferred.
Delta Dental of Kentucky Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religion gender sexual orientation gender identity national origin or veteran status.
Required Experience:
Unclear Seniority
Employment Type
Full Time
