What are the responsibilities and job description for the Claims Auditor position at Delta Dental of Michigan?
At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities for all. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.
At Delta Dental, we celebrate our All In culture. It’s a mindset, feeling and attitude we wrap around all that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community.
Typical Assignments:
- Analyzes, adjudicates, and processes dental claims so that non-clinical determinations can be finalized using policies, procedures, and bypasses.
- Reviews member’s group coverage to determine type and level of benefits
- Uses system and other sources to obtain information needed to process claim determinations, including DeltaUSA processing policies, group contracts, provider agreements, and federal and state laws applicable to claims adjudication
- Determines payment amounts when appropriate
- Reviews, modifies, and corrects claims in the system as needed, including claims that are not billable to patient
- Sends requests to dental offices seeking additional claims information, using proper grammar and punctuation
- Calculates basic mathematical functions
- Operates office equipment which may include a personal computer, calculator, copier, fax machine, etc.
- Maintains claim records and related departmental records and files
Bidding Requirements:
- Possess a high school diploma or equivalent
- Successful completion of a data entry test sponsored by Human Resources within the past 12 months / 7,000 keystrokes per hour with 95% accuracy (test waived if candidate currently holds or has previously held a CRT Operator position)
- Successful completion of a typing test administered by Human Resources within the past 12 months with a typing speed of 40 correct words per minute (minimum of 90% accuracy) (test waived if candidate currently holds a position that requires at least 40 correct words per minute.)
- One-year work experience in an office environment (external candidates only)
- Basic understanding in the use and operation of a personal computer
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