Sr. Dental Appeals Claims Examiner

Lincoln Financial•Papillion, NE

4d•Remote

About The Position

We are excited to be seeking a highly motivated Senior Dental Appeals Claims Examiner for our Claims Organization in a remote environment. As a Senior Dental Appeals Claims Examiner, you'll independently review denied dental claim appeals to ensure accurate, compliant, and timely decisions. Leveraging your knowledge of dental claims, ERISA, and state and federal regulations, you'll evaluate appeal requests, communicate clear and concise outcomes, and partner across teams to deliver a high-quality customer experience while protecting PHI. If you enjoy analytical problem-solving and making meaningful decisions, this role is for you.

Requirements

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

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.