Claims Examiner

Firstsource

6d•Onsite

About The Position

The Claim Processor/Adjustor is responsible for providing service to the DDIL clientbase through accurate processing of dental claims as well as troubleshooting and resolving all types of dental claim related inquiries.

Requirements

Excellent oral and written communications skills.
Strong computer keyboard skills.
Knowledge of insurance reimbursement practices, i.e. processing policies, deductibles, maximums, Coordination of Benefits (COB) and dental terminology.
Ability to work independently and execute multiple tasks simultaneously
Excellent attendance and punctuality record.

Nice To Haves

Can speak Spanish fluently
Can make diagnostic determinations based on provider claim narratives, dental photos and radiographs

Responsibilities

Investigate and process claims according to established business rules that have failed computer programmed edits
Provide guidance in claims processing requiring advanced technical and dental knowledge
Meet daily/weekly claim production goals as set by the ITL
Complete and maintain daily audit production logs
Accurately completes special projects assigned within specified time frame
Access EPHI following the current guidelines as established at the company-wide and department levels.
Maintain regular and punctual attendance
Perform other job-related duties as assigned (Professional Review, Appeals Review, E-Forms)
Update ITL or Manager regarding daily status of assigned reports by timeframe established by ITL or Manager.
Encouraged to work overtime according to business need.
Accesses EPHI following the current guidelines as established at the company- wide and department levels.
Maintains regular attendance and punctuality.
Performs other job-related duties as assigned.