[Remote] Sr. Claim Processing Representative, DentaQuest

Note: The job is a remote job and is open to candidates in USA. DentaQuest is a leader in managing dental and vision benefits for millions of Americans. The Sr. Claim Processing Representative is responsible for processing advanced and complex claims accurately and efficiently, while also resolving various claim scenarios and supporting the claims administration team.

Responsibilities

• Consistently process advanced & complex claim queues with a 99% or greater accuracy rate
• Uses business knowledge to resolve advanced claim processing scenarios including, but not limited to, COB (coordination of benefits), ORTHO (orthodontia) cases, TPL (third party liability), and manual pricing
• Responsible for adjustments to complex claims, as necessary, to meet corporate goals
• Process Direct Member Reimbursement claims, to include calling providers and members for missing information
• Serve as back up to Claim administration team by processing adjustments, posting check refunds and completing follow ups
• Serve as back up to Claim Research and Resolution team by researching and resolving claim issues
• May serve as back up to Team Lead in daily reporting
• Successful completion of more complex projects, as assigned
• Perform other duties as requested

Skills

• Associates degree and/or four years of experience in a business environment
• Strong math skills
• Previous claim processing experience required
• Attention to detail, accuracy and organization skills are essential
• Understanding of general insurance guidelines
• Ability to efficiently operate computer
• Strong interpersonal, written and verbal communication skills
• Self-motivation demonstrated by taking initiative to learn more and assume new challenges
• Cooperative, professional and effective interaction skills with co-workers, business partners and visitors
• Ability to work in excess of 40 hours in one week
• Ability to use Microsoft Office (Word, Excel and Outlook)
• Able to follow verbal and written instructions
• Ability to communicate in an active environment
• Ability to communicate via telephone or computer technology, via written and verbal channels

Benefits

• Generous vacation and sick time
• Market-leading paid family, parental and adoption leave
• Medical coverage
• Company paid life and AD&D insurance
• Disability programs
• Partially paid sabbatical program
• 401(k) employer match
• Stock purchase options
• Employer-funded retirement account

Company Overview