Claims Examiner

Delta Dental of New Jersey•Parsippany-Troy Hills, NJ

17h•$22•Hybrid

About The Position

Our Claims Examiners are provided with established company guidelines and examine and adjudicate dental claims using these guidelines, with expected levels of quality and productivity. During the first five weeks of employment, you will participate in full‑time, paid training conducted in the office five days per week, Monday through Friday, from 8:30 a.m. to 4:30 p.m. Following the completion of training, this role will transition to a full‑time, hybrid schedule working Monday through Friday from 8:00 a.m. to 4:30 p.m., with in‑office days on Tuesday and Wednesday and remote work on Monday, Thursday, and Friday. This position starts at $22.05 per hour and is benefits-eligible. The expected Start date for this position is April 20th, 2026.

Requirements

Personal computer skills with the ability to type 25 words per minute
Possess the ability to use Microsoft Word and Excel
Excellent written and oral communication skills
Ability to research and troubleshoot problems
Demonstrate good analytical and proofreading skills
Attention to detail
Good organizational skills
1-3 years claims processing or related service experience
Requires high school diploma or equivalent.

Nice To Haves

Dental Assistant education/experience preferred

Responsibilities

Accesses systems and keys claim data and other information and notations from work queues. Suspends, routes and adjudicates claims and performs research as required. Also, inputs fee filing data, as required
Creates and processes claims for pre-treatment estimates with payments.
Maintains and updates subscribers files with information obtained through inquiries and submitted claims and documents, i.e., family on hold codes applied or removed, student status deferred, addresses updated. Reports file discrepancies to management.
Responsible for researching and retrieving all documentation and resolving all claims in question, including student documentation, provider research, some coordination of benefits, diagnostics materials, etc.
Understands rejects and applies appropriate RFS codes as well as processing policies on applicable claims.
Requests information from providers and subscribers through telephone contact or written correspondence.
Resolves claims related system generated error and adjustment reports.
Supports and participates in completing claims related projects.
Acquire necessary skills through in-house training for Claim Examiner II position. Achieve Level II position within 36 months from start of Claims Examiner I.
When necessary, refers inquiries to management, dental consultants or appropriate outside organizations.
Provides management with required production figures as requested.
Other duties as assigned