Benefit SpecialistClaims
Benefit SpecialistClaims
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
- Administer analyze adjudicate and process claims in accordance with benefit contracts and plan policies; assist department to resolve claim issues; maintain claim records. Work closely with other departments for inquiries regarding claims processed.
- Crosstrain on various queues and jobs to allow for coverage when other staff members are out of the office.
- Perform coding and resolution of pending claims to meet or exceed department production standards.
- Provide character correction of claims or other documents submitted from customers or providers into our processing system. Manually enter claims on a limited basis.
- Review claims for proper documentation and route to Dental Consultants for review based on the procedures submitted. Work directly with the Dental Consultant to resolve issues and determine benefit.
- Mail letters with incomplete addresses to dentists and members for additional information. Determine documentation required if there is need for additional information.
- Maintain required production and quality standards established by the department and contribute to the accomplishment of team goals.
- Provide dental expertise and/or interpretation of dental policies procedures codes and processing guidelines to internal and external contacts. Recommend policy changes for the department.
- Receive and create an adjustment to indicate money is credited back to the claim; types of adjustments performed are corrections void/stop payment full refunds partial refunds adjust/no pay and reissues and special check requests when necessary.
- Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
Required Experience:
Unclear Seniority
Employment Type
Full Time
