The Claims Processing Specialist identifies and provides solutions for processing unique claims, refunds, overpayments, and underpayments. Other duties include processing special claims which may involve manual review of actual treatment compared to authorized treatment, and adjudicating VA CCN claims.
Responsibilities:
- Performs analysis of authorizations compared to submitted claims.
- Processes special claim payments, specifically for VA CCN client.
- Processes returned Delta Dental checks, personal checks, undeliverable checks, stale dated checks, and requests for voids/stop-payments/re-issues. Determines refund amounts, changes status of outstanding overpayments.
- Reviews monthly reports for outstanding overpayments and coordinates with finance on special issues.
- Reviews and handles special professional reviews and service issues, quality complaints and coordinates with Special Correspondence Unit.
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Qualifications:
- 1+ years of experience w/High School
- Two or more years as dental paraprofessional preferred. Some customer service experience and claims adjudication experience including the understanding of re-adjudication is preferred.
- Strong analytical and critical thinking skills.
- Ability to maintain strict attention to detail.
- Excellent customer service skills with ability to evaluate and respond to the contact needs.
- Ability to independently prioritize work and establish, understand, and follow work rules and procedures, and take action to improve existing processes.
- Ability to confront difficult situations and make appropriate and timely decisions.
- Excellent organizational skills, including the ability to follow-up on commitments on a timely basis and adhere to deadlines.
- Ability to collaborate effectively with others.
- Basic knowledge of accounting principles.
- Knowledge of Enterprise policies, procedures, and guidelines.
Base Pay Information
The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity.
Pay Grade 15. $40,500 - $84,800
Additional Information:
Behind the smile! We are dedicated to safeguarding the health and financial stability of our employees and their loved ones. This commitment extends beyond the workplace to foster personal growth and holistic wellbeing. Our life-changing rewards package includes:
- Competitive base and incentive pay
- 401(k) with robust matching and non-matching contributions
- Rich medical & pharmacy benefits
- 100% employer-paid dental and vision benefits
- Holistic wellbeing program with deep financial incentives
- Generous paid time off plus 12 paid holidays and your birthday off
- Culture of growth and learning: career development; tuition reimbursement; recognition program
- Family support: adoption assistance, fertility treatment, child, elder & pet care assistance
- Social responsibility and volunteer opportunities
- Employee discount program
Fair Chance Ordinances and Criminal Background Considerations
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all applicable federal, state, and local laws, including, but not limited to, fair chance and anti-discrimination ordinances. At Delta Dental, we maintain a strict stance on theft, fraud, and violent crimes. For positions involving driving, we enforce heightened standards regarding driving records. Each individual criminal background check is evaluated on its merits, taking into account the time elapsed since the conviction, evidence of personal development and rehabilitation, and any potential risk posed to our business operations, employees, customers, or vendors.
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