Claims Specialist Jobs

Job Title: Claims Processing Specialist

Type: 4 Month Contract to Start, Great Chance to Extend Longer Term

Location: 100% Remote, but must be in California for occasional onsite

Compensation: Please See Posting for Hourly Rate + Benefits Offered

Responsibilities:

• Processes related claims.
• Processes special claims payments specifically accident benefits and orthodontic.
• Determines refund amounts, defines AR amounts, and changes status of outstanding overpayments.
• Processes foreign claims by translating and determining price.
• Reviews and handles special professional reviews and services issues, and coordinates dental judgment with dentist consultants.
• Coordinates with accounting on special issues.
• Processes returned checks, personal checks, undeliverable checks, stale dated checks, and requests for voids/stop-payments/re-issues.
• Other duties include: processing special claims including manual check pricing, orthodontic and accident databases and reconciliation, as well as translating, deciphering, and adjudicating foreign claims. Performs miscellaneous duties as assigned.

Qualifications:

• A high school diploma or GED is preferred, but candidates with proven experience will not be excluded from consideration.
• Strong analytical, organizational and multi-tasking skills.
• PC literacy; MS Office skills (Outlook, Word, Excel).
• Close visual acuity required to read information on computer screens and written documents.
• Ability to clearly present written information and findings to all levels.
• Excellent customer service skills with ability to evaluate and respond to the contact needs.
• Regularly required to sit for long periods of time, and occasionally stand and walk.
• Ability to interact well with employees and outside contacts.
• Ability to independently prioritize work and establish, understand and follow work rules and procedures, and take action to improve existing processes.
• Ability to sit or stand 7.5 hours per day.
• A minimum of 2 years' experience in a dental office.
• Someone who has worked in a dental office would be ideal. Candidate should also know how to read x-rays.
• Ability to communicate in a clear and concise manner.
• Ability to hear voice communications.
• Ability to confront difficult situations and make appropriate and timely decisions.
• Basic knowledge of accounting principles.
• Ability to maintain consistent, regular attendance. Ability to report to perform tasks in a physical work environment.
• Must come with Medi-Cal / Denti-Cal Billing experience OR experience working with other dental or medical claims.
• Ability to work standard office equipment (personal computer, photocopy machine, fax machine, etc.).
• Ability to work expanded business hours including early morning, late evening and weekends
• Ability to speak and understand English clearly to communicate with external/internal customers.
• Applicant will be working off of their own equipment (laptop, phone).
• Knowledge of Enterprise polices procedures and guidelines.
• Ability to work at a computer up to 7 hours a day.