Claims Examiner

Job Title: Dental Claims Specialist

The role of a dental claims specialist is pivotal in delivering exceptional service to our customers. As a key member of the team, you will be responsible for managing and processing claims, resolving issues, and providing support to clients while maintaining our commitment to quality and integrity.

• Follow-up status of outstanding insurance claims, ensuring all follow-ups are properly documented and communicated by adding notations to the patient's account using track stat and commlog.
• Send out claims and attachments to insurance companies.
• Determine denial validity and address them properly.
• Generate OI reports and ensure monthly completion.
• Resubmit and reprocess claims, including grievances and appeals.
• Clear rejected claims on a weekly basis.
• Update the office tracker with all payments posted, including check scans and EFTs, and address any rejected claims.
• Complete assigned follow-ups on office spreadsheets.
• Generate EFT reports and retrieve EOBs from insurance portals for posting.
• Post insurance payments according to office preference, uploading EOBs and applying correct adjustments/WOs.
• Identify insurance process updates/issues and communicate findings with the team, ensuring insurances are open during work hours.
• Maintain professionalism at all times, adhering to work ethics and time schedules.
• Meet desired goals and accomplish tasks in a timely manner.
• Communicate with managers in the absence of attendance issues.