Claims Examiner

Ameritas • Lincoln, NE

4d • Remote

About The Position

The Claims Examiner processes dental claims by using claims knowledge in accordance with the specific policy and/or processing guidelines. This position provides service to customers by communicating with providers and insureds to professionally evaluate claims or answer general inquiries under limited supervision.

Requirements

• H.S. Diploma or GED required
• 0-2 years related experience required
• Must possess problem solving and analytical skills.
• Organizational and time management skills
• Must possess good grammar in speaking and writing; should have good verbal skills in formal and informal business settings and be able to write clearly.
• Proficient use of personal computer system and keyboarding skills.
• Ability to quickly adapt to new procedures and job functions derived from changes in laws and business relationships.

Nice To Haves

• Experience in a dental related field or claim processing environment helpful.

Responsibilities

• Review and provide resolution for claims rejected by the auto-adjudication process in accordance with the departmental accuracy and responsiveness standards using the claims/image system and various sub-systems.
• Recognize procedure codes, tooth numbers, etc. and understand how they interrelate to ensure claims for all products were processed appropriately. (Functions will include claims processes for all products - dental, vision and hearing products.)
• Resolve inquiries and problems and arrive at a quick, accurate and satisfactory resolution. Manually process claim re-submissions.
• Knowledge of various contracts and marketing arrangements including PPO contracts and service guarantees. Interpretation of coordination of benefits and other policy provisions, company practices and transition guidelines.
• Apply policy provisions and knowledge of company philosophy to ensure compliance with the contract, legal requirements and guidelines established by various states' regulations.
• Provide second review of claims.
• Work the front desk, either as primary, back-up, or as part of a rotation with other associates.
• Ability to work periods of overtime as required based upon business need.
• Other duties as assigned

Benefits

• 401(k) Retirement Plan with company match and quarterly contribution.
• Tuition Reimbursement and Assistance.
• Incentive Program Bonuses.
• Competitive Pay.
• Flexible Hybrid work.
• Thrive Days - Personal time off.
• Paid time off (PTO).
• Health Benefits: Medical, Dental, Vision.
• Health Savings Account (HSA) with employer contribution.
• Well-being programs with financial rewards.
• Employee assistance program (EAP).
• Professional development programs.
• Leadership development programs.
• Employee resource groups.
• StrengthsFinder Program.
• Matching donations program.
• Paid volunteer time– 8 hours per month.
• Generous paid maternity leave and paternity leave.
• Fertility, surrogacy, and adoption assistance.
• Backup child, elder and pet care support.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED