Dental Appeals Sr. Claims Examiner,

Lincoln Financial•Papillion, NE

12d•Remote

About The Position

This position is responsible for the review of Dental appeals by providing an independent review of the facts and circumstances, within the state and federal regulations including ERISA/DOL. In this role, you will act on new dental appeals within 5 business days, and render appeal decisions within 15 days for pre-service, and 30 days for post-service. Written communication of appeal upholds will be clear and concise, and site decision rationale in clear, easy to understand terms. You will partner with other departments, such as Enrollments and DentalConnect as needed, while adhering to PHI.

Requirements

High School diploma or GED or minimum Associate degree in lieu of required experience. (Minimum Required)
3 - 5+ Years of claims processing experience directly aligned to the specific responsibilities for this role. (Required)

Nice To Haves

3-5 years experience processing dental claims.
Understand dental medical terms, records and test results.
Ability to read, analyze and interpret Dental policies.
Demonstrate strong written and verbal communication.
Ability to work with others in a team environment.
Demonstrates excellent organizational skills with the ability to prioritize workload and multi-task while maintaining strict attention to detail.
Demonstrates strong interpersonal skills with a collaborative style.
Demonstrates the ability to use sound judgment and discretion regarding confidential information

Responsibilities

Analyze & process claims by investigating information.
Apply claim policies & procedures and engages intervention of internal/external resources to ensure fair, ethical, & timely management of assigned claims.
Analyze and interpret complex coverage contracts to determine if eligibility is met.
Liaise with various stakeholders from across the business (Enrollments, DentalConnect) to obtain needed information to clarify and address issues.
Provide customers with explanations of policy details and claim determination.
Effectively utilize and implement policies & procedures regarding overall claims workflow.
Propose and develop practices & processes to improve performance and the customer experience.
Work as an individual and part of a team to ensure all new appeal assignments are acted on within department turnaround times.