Claims Analyst ~ Dental Insurance

Northeast Delta Dental•Concord, NH

4d•Remote

About The Position

Northeast Delta Dental is seeking a full-time, remote Claims Analyst to join their Claims Edit Department in Concord, NH. The role involves assuring accurate adjudication, refunds, and adjustments of dental claims by reviewing, researching, and/or returning suspended dental claims in accordance with appropriate departmental processes. The company has been recognized as one of the Best Companies to Work For in New Hampshire.

Requirements

At least two years claims processing or insurance related experience, or an equivalent combination of training, experience, and/or education.
Must be proficient in Microsoft Excel and Word.
Must possess thorough knowledge of CDT coding and dental terminology.
Must be able to perform routine mathematical computations and calculations.
All Candidates must be authorized to work for any employer in the United States without sponsorship now and in the future.

Responsibilities

Adjudicates claims using Northeast Delta Dental and New England Dental Administrators, LLC, processing policies by reviewing, correcting, editing, and researching suspended claims; contacts dental offices, as necessary, to obtain routine missing information or to correct information.
Researches, corrects and processes claims queries.
Processes claims requiring special handling, special consideration, and manual pricing by following the applicable processes noted in the department manual outlined for specific programs/groups/benefits (for example, Ortho, Head Start, Exchanges, New England Dental Administrators, LLC).
Resolves Dental Coordination of Benefits (COB), Dual Delta, and medical claims based on coordination of benefits guidelines; ensures the accuracy of benefits allocation between primary and secondary dental and medical carriers.
Calculates refunds for the Customer Service staff, verifies coordination of benefits resolutions and provides information to questions about claims payments.
Assures appropriate documentation, X-rays, and/or any applicable notes are attached before forwarding claims to consultant review by reviewing claims and returning claims missing information to the dental offices.