Claims Specialist I

Renaissance Life & Health Insurance Company of America • Indianapolis, IN

1d • Hybrid

About The Position

Renaissance Benefits is hiring for a Dental Claims Specialist! At Renaissance, the Dental Claims Specialist analyzes and adjudicates claims to ensure accurate benefits administration. This role involves accurately analyzing and processing dental claims to ensure appropriate determinations are finalized with correct procedures, policies, and bypasses. The specialist will administer claim processing guidelines/standards, Renaissance processing policies, group contracts, provider agreements, and state laws applicable to claims adjudication. They will review all submitted information to ensure accurate processing of dental claims, including interpretation of radiographs, periodontal charts, and chart notes. Additionally, the role includes reviewing and preparing orthodontics and complex service claims for processing, performing manual entry of claims that failed EDI transmission, and maintaining related departmental documents. The Claims Specialist will also provide interpretation of processing guidelines to internal and external contacts, and perform other responsibilities as assigned by the department Supervisor.

Requirements

• High school diploma or equivalent
• Knowledge of dental terminology and dental procedures
• Ability to read and interpret radiographs, electronic images and photos
• Effective verbal and written communication skills
• Ability to resolve complex problems and use independent judgment
• Will accept any suitable combination of education, training, or experience.

Nice To Haves

• Minimum of one year dental insurance processing experience is preferred
• Will accept other medical insurance experience

Responsibilities

• Accurately analyzes and processes dental claims so appropriate determinations can be finalized with correct procedures, policies, and bypasses.
• Administers claim processing guidelines/standards, Renaissance processing policies, group contracts, provider agreements, and state laws applicable to claims adjudication.
• Reviews all information submitted to ensure accurate processing of dental claims including interpretation of radiographs, periodontal charts, and chart notes.
• Reviews and prepares orthodontics and complex service claims for processing.
• Performs manual entry of claims that failed EDI transmission.
• Maintains related departmental documents and provides interpretation of processing guidelines to internal and external contacts.
• Other responsibilities as assigned by department Supervisor.

What This Job Offers

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