Dental Claims Specialist

Dental Claims Specialist

As a Dental Claims Specialist, you will play a critical role in delivering exceptional service to our customers. You will be responsible for managing and processing claims, resolving issues, and providing support to our clients while upholding our commitment to quality and integrity.

Responsibilities include :

• Follow-up status of outstanding insurance claims, make sure all follow-ups are properly documented and communicated by always adding a notation to the patient's account (using the track stat and commlog).
• Send out claims and attachments to insurance.
• Determine denial validity and properly address them.
• Generate OI reports and ensure monthly completion.
• Claim resubmission and reprocessing, including grievance and appeals.
• Clear rejected claims on a weekly basis.
• Update weekly office tracker to include all payments posted (check scans and EFTs) and if all rejected claims were addressed.
• Complete all follow-ups assigned (on the office spreadsheets).
• Generate EFT reports and retrieve EOBs from insurance portals for posting 100%.
• Insurance payment posting - follow office preference, always upload EOB, and apply correct adjustment / WO.
• Identify any insurance process updates / issues and communicate findings with the team.
• Required to remain professional at all times, observing work ethics and adhering to the work time schedule.
• Expected to hit the desired goal and accomplish all tasks in a timely manner.
• Expected to communicate with the manager in the absence of any attendance issues.