Government Programs Professional Review Claims Specialist - Remote

Overview

The Government Programs Professional Review Claims Specialist at Delta Dental is responsible for analyzing and adjudicating dental claims to ensure accurate benefits administration.

In Short

• Analyze and process dental claims with complicated treatment plans.
• Ensure accurate benefits administration according to policies and guidelines.
• Investigate provider reconsideration requests and make determinations.
• Provide dental expertise to internal and external contacts.
• Organize and perform defined test cases on claims processing systems.
• Research and adjudicate Third Party Liability claims.
• Maintain claim records and compile data for reports.
• Collaborate with contracted dentists on questionable treatment cases.
• Utilize effective communication skills for problem resolution.
• Participate in continuous improvement initiatives.

Requirements

• Associate's degree or equivalent education in a related field.
• Two years of experience in chair side assisting.
• RDA or RDH licensure preferred.
• Advanced knowledge of dental terminology and procedures.
• Ability to read and interpret radiographs and electronic images.
• Experience with word processing and spreadsheet software.
• Effective verbal and written communication skills.
• Ability to resolve complex problems using independent judgment.
• Experience with provider systems and client contracts preferred.
• Commitment to diversity and equal opportunity.

Benefits

• Comprehensive medical, dental, and vision coverage.
• Short- and long-term disability insurance.
• Life insurance and 401(k) savings plans.
• Flexible spending accounts.
• Tuition reimbursement or educational assistance.
• Annual incentive compensation based on business goals.
• Eight hours of paid volunteer time each year.
• Access to an on-staff health coach and personal trainer.
• Other employee perks and benefits.