Responsibilities:
- Claim Review and Analysis: Review, analyze, and make decisions on dental claims in accordance with policy and state/federal regulations.
- Data Verification: Apply knowledge of claims procedures, product design, contract provisions, and regulations to make accurate and timely claim decisions.
- Eligibility and Benefit Levels: Determine eligibility, verify data input, identify correct benefit levels, and manage coordination of benefits and corrections.
Qualifications:
- Educational Requirements:
- Bachelor of Dental Surgery (BDS) is required.
- Experience:
- 1-2 years of experience in the financial services, insurance industry, claims processing, or dental insurance is preferred.
- Experience with medical/dental terminology is a plus.
- Skills:
- High attention to detail and accuracy.
- Strong written and verbal communication skills.
- Basic math skills for claim payment calculations.
- Ability to work independently and within a team environment.
- Proficiency in MS Office and navigating technology solutions.
- Ability to maintain confidentiality and work in a fast-paced, production-driven environment.
Additional Information:
- Shift Timing:
- Training time: 5:30 PM to 2:30 AM (night shift).
- Regular work timing: 1:30 PM to 10:30 PM.
- Preferred Qualifications:
- Experience in claims processing or the medical/dental industry is preferred.
- Industry courses (such as LOMA) are a plus.
