Dental Claims Resolution Specialist

Job Summary

A company is looking for a Dental Claims Resolution Specialist to investigate, recover, and resolve claims while educating members and providers on program coverage.

Key Responsibilities

• Manage assigned claims inquiries, including assessment and coordination for members and healthcare providers
• Establish and maintain relationships with members, providers, and claims contractors
• Request and manage medical records, prepare summaries for claim appeals, and document outcomes of claims investigations

Required Qualifications

• Minimum of three years of claims processing or similar experience
• Equivalent combination of education, experience, and/or applicable military experience will be considered
• Proficient computer skills with Microsoft Office Suite experience
• Ability to work independently and collaboratively within a team
• Must be able to implement critical thinking and decision-making skills for various member care/treatment plans