Dental Claims Support I
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About The Position
Let's do great things, together! At Moda Health, we are committed to quality healthcare and outstanding coverage for our members. Founded in Oregon in 1955, we focus on building a better future for healthcare by providing compassionate support to our community and comprehensive benefits to our employees. Our commitment to diversity and inclusion is reflected in our workplace, and we invite applications from candidates who share this commitment. The Dental Claims Support I position plays a crucial role in our operations by providing backup support to leads, including the training of staff. This role involves investigating complex file reviews and processing complex claims adjustments, including Coordination of Benefits (COB) claims. The position requires handling phone calls, overpayment recoveries, stop pays, and void checks. Additionally, the Dental Claims Support I is responsible for sorting, assigning, and working various reports, such as building member accumulators, giving deductible credits, and adjusting claims to correct various provider updates. In this role, you will be expected to understand and follow compliance rules to process claims accurately and timely. You will document thoroughly as required by internal procedures and market conduct guidelines, analyzing and interpreting existing file notes and documentation. Excellent knowledge and understanding of Delta Dental contractual and administrative policies affecting claims is essential. You will communicate with members, providers, and other insurance carriers, ensuring that requests are within contractual and administrative guidelines. The position also involves performing basic and complex adjustments on previously processed claims using various tools and systems, investigating and processing COB claims, and providing suggestions for potential process improvements. The working environment is an office setting with extensive close PC and keyboard work, constant sitting, and phone work. You will need to navigate multiple screens and may be required to work in excess of 37.5 hours per week, including evenings and occasional weekends, to meet business needs. Together, we can be more. We can be better.
