Claim Benefit Specialist - Ops

Description: • The Dental Claim Benefit Specialist reviews and adjudicates routine dental claims in accordance with claim processing guidelines. • Ability to work independently. • Ability to think logically and problem solve. • Strong oral and written communication skills. • Analyzes and approves routine claims that cannot be auto adjudicated. • Applies dental/medical necessity guidelines, determines coverage, coordinates benefits, completes eligibility verification, identifies discrepancies, and applies all cost containment measures to assist in the claim adjudication process. • Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements. Requirements: • Working knowledge of problem solving and decision making skills. • Experience in a production environment. • 1 year Medical Claims processing or Customer Service experience (Commercial, Dental, Medicaid, Medicare, etc.) • Analytical skills, with the ability to research particularly in areas involving rejected claims. • Demonstrated ability to handle multiple assignments competently, accurately, and efficiently. • Demonstrated proficiency with personal computer and keyboard navigation skills. Benefits: • Affordable medical plan options, • a 401(k) plan (including matching company contributions), • an employee stock purchase plan . • No-cost programs for all colleagues including wellness screenings, • tobacco cessation and weight management programs, • confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, • flexible work schedules, • family leave, • dependent care resources, • colleague assistance programs, • tuition assistance, • retiree medical access and many other benefits depending on eligibility. Apply Job!