Dental Claims Examiner/ Provider Services

Job Description

Title: Denta lClaims Examiner/ Provider Services

Overall Responsibility: To deliver high quality customer service to doctors or doctor’s office staff, members, community partners and plan sponsor representatives in a professional, respective and helpful manner. Process claims in a timely, accurate manner.

Reports to: Director of Constituent Services

Location: Location: Bala Cynwyd, PA

Schedule: Hybrid In-Office/Work from Home; Minimum designated 2 days per week in-office.

Key responsibilities and accountabilities:

• Respond to inbound telephone calls, faxes and emails from doctors or doctor’s office staff, and plan sponsor representatives in a timely and professional manner;
• Respond to inbound telephone calls, faxes and emails from members or member representatives in a timely and professional manner;
• Process dental claims on system for all clients;
• Process claim corrections from daily EDI reports;
• Document communications with doctors and doctor’s office staff, and plan sponsor/employer representatives;
• Document communications with members and member representatives;
• Respond to claim inquiries from subscribers, doctors and plan sponsor/employer representatives in a timely and professional manner;
• Respond to benefit coverage inquiries from members and member representatives in a timely and professional manner;
• Respond to eligibility inquiries from subscribers, doctors and plan sponsor/employer representatives in a timely and professional manner;
• Maintain department productivity and quality expectations;
• Maintain knowledge of dental plan designs, exclusions, limitations and exceptions for each client;
• Adhere to all process and procedural guidelines;
• Any other duties as assigned

Skills and Attributes:

• Ability to provide outstanding service
• Ability to work independently to achieve goals and objectives within defined timeframes
• Ability to process information through computer systems
• Ability to adjust priorities and manage time wisely in a fast-paced environment;
• Ability to communicate in a clear, concise, understandable manner, and listen attentively to others;
• Ability to prioritize and manage workflow;
• Ability to meet deadlines;
• Knowledge of CDT codes and dental terminology;
• Team player; ability to get along well with others and function as part of a work group;
• Excellent data entry skills;

Experience:

• Prior experience as a dental assistant or in dental office management;
• Dental claims and/or dental office billing experience;
• Basic knowledge of MS Windows, MS Word, MS Excel;
• Strong organizational skills;
• Multilingual a plus.

Job Type: Full-time

Pay: $35,415.00 - $40,271.00 per year

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to Commute:

• Bala-Cynwyd, PA 19004 (Required)

Ability to Relocate:

• Bala-Cynwyd, PA 19004: Relocate before starting work (Required)

Work Location: Hybrid remote in Bala-Cynwyd, PA 19004

Salary : $35,415 - $40,271