Claim Examiner II

Delta Dental • Alpharetta, GA

3d

About The Position

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.

Requirements

• 3+ years of experience w/High School
• 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.
• Required to successfully complete level 1 and level 2 training and examinations.

Nice To Haves

• 2+ years’ experience in a similar role
• Associate degree preferred.
• Knowledge of Delta Dental systems/organization and knowledge of health care industry issues preferred.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees