Delta Dental of Michigan ยท 9 hours ago
Professional Services Claims Specialist (Review)
Okemos, MI
Full-time
Remote
Entry Level
2+ years exp
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Responsibilities
Analyzes and processes dental claims so appropriate determinations can be finalized with correct procedures, policies, and bypasses; adjudicates claims, and maintains claim records.
Administers claim processing guidelines/standards, Delta USA processing policies, group contracts, provider agreements, and state laws applicable to claims adjudication.
Investigates difficult provider reconsideration requests, makes determinations, performs or coordinates adjustments; prepares claims for a second and/or third opinion when necessary and consults with contracted dentists on questionable treatment cases.
Pre and post-screens claims and/or inquiries for dental consultant(s); reviews and prepares claims for and coordinates external dental consultant activities.
Provides dental expertise and/or interpretation of dental policies, procedures codes, and processing guidelines to internal and external contacts.
Organizes, creates, and performs defined test cases on claims processing system, and documents/reports status of testing including recommendations for improvements. Analyzes and compiles information/data for reports to control and/or monitor claims inventory.
Researches, coordinates, and adjudicates Third Party Liability claims and recoveries; compares member information, prepares claims, and performs adjustments as necessary to ensure proper Third Party Liability (COB) adjudication.
Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
Qualification
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Required
Position requires an associate's degree, technical, vocational, or business school with coursework related to dentistry and two years of experience in chair side assisting.
Position requires advanced knowledge of dental terminology and dental procedures and the ability to read and interpret radiographs, electronic images and photos.
Experience working with word processing and spreadsheet software.
Effective verbal and written communication skills.
Ability to resolve complex problems and use independent judgment.
Experience with provider system; client contracts and Roosevelt.
Preferred
An RDA or RDH licensure is preferred.
Experience with provider system; client contracts and Roosevelt is preferred.
Company
Delta Dental of Michigan
Delta Dental of Michigan, with its affiliates in Arkansas, Indiana, Kentucky, New Mexico, North Carolina, Ohio and Tennessee
501-1000 employees
H1B Sponsorship
Delta Dental of Michigan has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (15)
2022 (14)
2021 (20)
2020 (25)
Funding
Current Stage
Late StageLeadership Team
Jed Jacobson
Chief Science Officer/Senior Vice President
Andrew Woodard
Vice President, Chief Information Security Officer
Company data provided by crunchbase
