Dental Claims Examiner Trainee

Responsibilities:

• Work with trainer and/or assigned co-worker to learn and perform review of plan documents and procedures to apply plan provisions, limitations and exclusions when making benefit determinations.
• Learn to request information to complete or review claims using standard procedures and letters, and asks questions as needed.
• Must demonstrate ability to learn and grow with continuous improvement and ability to increase average daily claim production while maintaining accuracy and quality.
• Performs computations and processes claims independently up to the dollar threshold set by thetrainer not to exceed the job classification maximum of $1,500.00.
• Learns to perform duties and prepare to become a Claims Examiner by meeting training objectives and expected production metrics.
• Communicates efficiently by telephone, in writing or in person with all personnel, members, providers, external vendors or others regarding claim benefit questions or information.
• Communicates with the Quality Assurance Supervisor in conjunction with their trainer as necessary to request and receive data on pending claims.
• Learns to apply procedures to third-party liability claim claims.
• Exercises professional judgment on daily tasks and seeks approval from supervisor or trainer when faced with new or unfamiliar tasks.
• Maintain a 10 business-day turnaround time on assigned claim responsibilities.
• Maintain and update a pending file with follow-ups on correspondence as required.
• Ability to meet production and quality goals on a consistent basis as outlined within training.
• Routes claims requiring review to the assigned Claim Adjuster Senior II.
• Demonstrates knowledge of assigned duties as well as the legacy and the recently migrated claims processing system.
• Perform other duties as assigned.

Minimum qualifications:

• 6 months or more within a Claims Pre-Processor position Or
• 6 months in another position with field related experience.
• Working knowledge of basic office equipment.
• Positive interpersonal communications with internal personnel, external clients and vendors.
• Demonstrated ability to keep calm and positive within all communications.
• Proven ability to accurately and timely review and edit documents.
• Utilize computer, phone systems and reference materials to be able to effectively perform the essential functions of the position.
• Previous experience utilizing Microsoft office software.
• High school diploma or G.E.D

Job Type: Full-time

Pay: $19.87 - $22.08 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance

Schedule:

• Monday to Friday

Travel requirement:

• No travel

Work setting:

• In-person
• Office

Work Location: In person