Senior Dental Appeals Claims Examiner

This is a fully remote position, open to applicants in Nebraska.

📋 Description

• Conduct independent reviews of denied dental claim appeals.

• Evaluate and process claims through thorough investigation of information.

• Implement claim policies and procedures while collaborating with internal and external resources.

• Analyze and interpret intricate coverage contracts to ascertain eligibility.

• Coordinate with Enrollments, DentalConnect, and other stakeholders to gather necessary information.

• Clarify policy details and claim resolutions to customers.

• Establish policies and procedures for claims workflow management.

• Recommend and create practices and processes aimed at enhancing performance and customer satisfaction.

• Work autonomously and collaboratively as part of a team to address appeal assignments within departmental turnaround times.

• Ensure decisions are accurate, compliant, and timely while safeguarding PHI.

⛳️ Requirements

• High School diploma or GED, or a minimum of an Associate degree in place of required experience.

• 3–5+ years of experience in dental claims processing directly relevant to this role.

• Familiarity with dental medical terminology, records, and test results.

• Capability to read, analyze, and interpret dental policies.

• Excellent written and verbal communication skills.

• Ability to collaborate effectively within a team environment.

• Strong organizational skills with the capacity to prioritize tasks and manage multiple responsibilities while maintaining a keen attention to detail.

• Exceptional interpersonal skills with a collaborative approach.

• Good judgment and discretion regarding confidential information.

🏝️ Benefits

• Clearly defined career tracks and job levels.

• Opportunities for leadership development and virtual training.

• Paid time off and parental leave.

• Competitive 401K and employee benefits.

• Complimentary financial counseling, health coaching, and employee assistance program.

• Tuition assistance program available.

• Flexible work arrangements offered.

• Access to productivity and technology tools, along with training.

• Eligibility for the Annual Incentive Program.

• Potential long-term incentives and sales incentives.