Claims Specialist III

Careington International Corporation•Frisco, TX

13h•Hybrid

About The Position

The Claims Specialist III supports the Claims department with claims processing, recoupment, auditing, training, and issue resolution. The role identifies errors and defects, helps resolve related issues, and applies claims knowledge accurately and efficiently. The position requires a self-starter with strong attention to detail. The role is currently hybrid, with onsite attendance required three days per week at the corporate office in Frisco, Texas. Beginning in Spring/Summer 2027, onsite attendance will be required five days per week. The position also supports department efficiency initiatives and performs additional assigned duties and special projects as needed.

Requirements

Advanced computer skills and experience with Microsoft applications, including Adobe, Excel, Word, and Outlook.
Ability to learn office applications and Careington systems readily.
Claims processing background within the medical or dental industry.
Strong organization and ability to manage multiple tasks effectively.
Initiative and ability to work independently with minimal supervision.
Ability to work in a deadline-driven environment.
Clear oral and written communication skills and ability to interact effectively with internal and external contacts.
Ability to apply knowledge after training to research and resolve claims appropriately.
Strong work ethic and adaptability as business plans evolve.
Accuracy in data entry and a focus on error-free work.
Discipline and attention to procedures, agreements, and document flows.
Efficiency and ability to balance quality and quantity.
Ability to handle confidential dental information discreetly.
Ability to operate standard office equipment and keyboards.
Ability to walk short distances; stand, walk, and sit; talk or hear in person and by telephone; use hands to finger, handle, or feel objects or controls; reach with hands and arms; and regularly stoop, kneel, bend, crouch, and lift up to 25 pounds.
Vision abilities required include close vision, distance vision, depth perception, color vision, and ability to adjust focus.

Nice To Haves

Associate degree or an equivalent combination of education and experience.

Responsibilities

Reprocess first-submission claims with issues.
Process refunds and recoupments.
Complete W-9 updates.
Assist with escalated portal issues that the contact center cannot handle.
Manage member and provider claim research issues submitted by the Contact Center.
Create training curriculum and materials based on identified needs.
Conduct new-hire, refresher, and ad hoc training for team members who need focused support.
Monitor training activities, evaluate program success, and adjust programs to improve outcomes.
Complete client audits according to their requested funds schedule.
Complete monthly audits of claims team members.
Complete ad hoc audits, including focused, team member, provider, and procedure audits.
Proactively identify errors related to claims pre-payment and adjudication, assess trends, and recommend solutions to reduce defects.
Support department initiatives to improve overall efficiency.
Perform additional assigned duties and special projects as needed.