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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