Claim Benefit Specialist - Ops
Description:
- The Dental Claim Benefit Specialist reviews and adjudicates routine dental claims in accordance with claim processing guidelines.
- Ability to work independently.
- Ability to think logically and problem solve.
- Strong oral and written communication skills.
- Analyzes and approves routine claims that cannot be auto adjudicated.
- Applies dental/medical necessity guidelines, determines coverage, coordinates benefits, completes eligibility verification, identifies discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
- Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.
Requirements:
- Working knowledge of problem solving and decision making skills.
- Experience in a production environment.
- 1 year Medical Claims processing or Customer Service experience (Commercial, Dental, Medicaid, Medicare, etc.)
- Analytical skills, with the ability to research particularly in areas involving rejected claims.
- Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.
- Demonstrated proficiency with personal computer and keyboard navigation skills.
Benefits:
- Affordable medical plan options,
- a 401(k) plan (including matching company contributions),
- an employee stock purchase plan .
- No-cost programs for all colleagues including wellness screenings,
- tobacco cessation and weight management programs,
- confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off,
- flexible work schedules,
- family leave,
- dependent care resources,
- colleague assistance programs,
- tuition assistance,
- retiree medical access and many other benefits depending on eligibility.
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