This position is responsible for reviewing more complex dental, vision and/or other various assigned claim types for accuracy and compliance with group and Delta processing guidelines. The Claims Examiner will also process claims, achieving the minimum acceptable number of claims per day at or above the current acceptable accuracy/quality rates.
Responsibilities:
- Performs first- and second-level claim review and inputs corrections to enable system adjudication of claims.
- Adjudicates claims in accordance with company and/or regulatory guidelines.
- Collaborates with appropriate department(s) based on company and/or regulatory guidelines to enable accurate claim adjudication.
- Refer escalated claims or process issues to management as appropriate.
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Qualifications:
- 3+ years of experience w/High School
- 2+ years' experience in a similar role; Associate degree preferred. Required to successfully complete level 1 and level 2 training and examinations.
- Analytical, problem solving and reasoning skills; detail orientation.
- Good organizational/time management skills and multi-tasking abilities.
- Ability to work under pressure and meet deadlines.
- Ability to follow verbal and written instructions.
- Ability to effectively communicate problems/questions/explanations.
- Knowledge of Delta Dental systems/organization and knowledge of health care industry issues preferred.
Base Pay Information
The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity.
Pay Grade 14. $36,900 - $74,600