What are the responsibilities and job description for the Benefit Specialist/Claims position at Delta Dental of Kentucky, Inc?
Delta Dental of Kentucky is looking for a dynamic individual to fill the role of Benefit Specialist in our Louisville, Kentucky office.
Job Summary:
To analyze and adjudicate dental claims while working in a variety of areas. Provide support within the Claims department and across the organization in resolving claims related issues.
Primary Job Responsibilities:
- Administer, analyze, adjudicate and process claims in accordance with benefit contracts and plan policies; assist department to resolve claim issues; maintain claim records. Work closely with other departments for inquiries regarding claims processed.
- Cross-train on various queues and jobs to allow for coverage when other staff members are out of the office.
- Perform coding and resolution of pending claims to meet or exceed department production standards.
- Provide character correction of claims or other documents submitted from customers or providers into our processing system. Manually enter claims on a limited basis.
- Review claims for proper documentation and route to Dental Consultants for review based on the procedures submitted. Work directly with the Dental Consultant to resolve issues and determine benefit.
- Mail letters with incomplete addresses to dentists and members for additional information. Determine documentation required if there is need for additional information.
- Maintain required production and quality standards established by the department and contribute to the accomplishment of team goals.
- Provide dental expertise and/or interpretation of dental policies, procedures codes, and processing guidelines to internal and external contacts. Recommend policy changes for the department.
- Receive and create an adjustment to indicate money is credited back to the claim; types of adjustments performed are corrections, void/stop payment, full refunds, partial refunds, adjust/no pay and reissues, and special check requests when necessary.
- Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
Minimum Qualifications:
Position requires a high school diploma or equivalent. Three years' experience working in a medical or dental related claims position preferred. Dental assistant training or certification and/or related dental office experience a plus. Will accept any suitable combination of education, training, or experience.
Position requires intermediate PC keyboarding and Microsoft Windows-based programs, and candidate must meet the company’s PC testing standards to be considered. Strong communication skills and the ability to learn and access different queues to allow work in a variety of queues at one time throughout the workday required.
Delta Dental of Kentucky, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, or veteran status.
