Claims Processor
About The Position
Under the supervision of the Claims Manager, the Claims Processor accurately performs functions related to dental claims processing and follows processing rules, guidelines, and policies. The role is accountable for meeting department productivity, quality, and accountability standards. The position handles claims imaging and data entry, processes multiple types and levels of dental claims, reviews suspended electronic claims, and processes requests to pay pre-authorizations. It also supports department procedures, other departments as needed, assigned projects, annual goals, and a customer-focused approach to timely and accurate claims processing.
Requirements
- High school diploma or equivalent.
- At least two years of clerical experience, customer service, sales, or a combination of education and experience that provides the necessary knowledge, skills, and abilities.
- Demonstrated customer service skills and sales ability.
- Ability to maintain focus and attention to detail.
- Ability to handle multiple tasks with some distractions.
- Ability to communicate orally and in writing with staff at all levels, customers, and vendors.
- Ability to handle information confidentially and comply with federal and state laws and regulations, including HIPAA and PHI requirements.
Nice To Haves
- Working knowledge of PC applications, such as word processing and spreadsheets.
Responsibilities
- Electronically images hardcopy claims batches as OCR and non-OCR, including x-ray attachments.
- Batch images paper attachments, POAs, and adjustments, and performs back-end imaging of claims documentation.
- Inputs rejected and RFI claims notices.
- Performs claims data entry, including verifying required documentation.
- Processes Levels 1, 2, and 3 claims, including single, COB-S, dual, pre-authorizations, and out-of-state claims.
- Reviews all levels of suspended electronic claims, including opening and sorting ECS mail.
- Processes requests to pay pre-authorizations.
- Assists the Claims department in following established document policies and procedures.
- Provides backup support and assistance in Customer Service and other departments as necessary.
- Completes special projects as assigned.
- Develops and follows through on a plan to meet annual goals established with the supervisor.
- Takes responsibility for relationships with others in the department and company, and works as a team player wherever there is a need.
- Maintains a customer-advocate attitude and recognizes the importance of timely and accurate claims processing to customer satisfaction.
- Performs other miscellaneous duties and responsibilities as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
