Claims Examiner

Delta Dental of New Jersey is currently hiring Claims Examiner to examine and adjudicate dental claims,. This position is full time and hybrid, and our schedule is in office Tuesday and Wednesday, and remote Monday, Thursday and Friday. Beginning in January, all associates will be in the office Tuesday, Wednesday and Thursday, and remote Monday and Friday. Located in Parsippany NJ, Delta Dental is the largest dental insurance provider in New Jersey, providing coverage to more than 1.8 million members and subscribers.

This is an hourly position starting at $22.05/hour and is full time. During your first 5 weeks, we will provide you with the training you'll need to be successful in your work. We offer medical, dental, Rx and vision benefits, matching 401k, tuition reimbursement and paid time off. Come join a great company and get your smile on

Essential Functions & Responsibilities

• Accesses systems and keys claim data and other information and notations from work queues. Suspends, routes and adjudicates claims and performs research as required. Also, inputs fee filing data, as required

• Creates and processes claims for pre-treatment estimates with payments.

• Maintains and updates subscribers files with information obtained through inquiries and submitted claims and documents, i.e., family on hold codes applied or removed, student status deferred, addresses updated. Reports file discrepancies to management.

• Responsible for researching and retrieving all documentation and resolving all claims in question, including student documentation, provider research, some coordination of benefits, diagnostics materials, etc.

• Understand system rejects and applies appropriate RFS codes as well as processing policies on applicable claims.

• Requests information from providers and subscribers through telephone contact or written correspondence.

• Resolves claims related system generated error and adjustment reports.

• Supports and participates in completing claims related projects.

• Acquire necessary skills through in-house training for Claim Examiner II position. Achieve Level II position within 36 months from start of Claims Examiner I.

• When necessary, refers inquiries to management, dental consultants or appropriate outside organizations.

• Provides management with required production figures as requested.

• Other duties as assigned

Essential Qualifications

Competencies

Adaptability-Flexibility

Communication Skills

Computer Skills

Customer Focus

Dependability

Job Knowledge

Productivity

Quality

Teamwork

Technical and Functional Requirements

• Personal computer skills with the ability to type 25 words per minute
• Possess the ability to use Microsoft Word and Excel
• Excellent written and oral communication skills
• Ability to research and troubleshoot problems
• Demonstrate good analytical and proofreading skills
• Attention to detail
• Good organizational skills

Key Performance Indicators

• Meet-exceed CPH of 30 or above
• Maintain TQM of 99% or higher

Required Physical Abilities

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to sit and perform extensive close keyboard and PC work
• Ability to walk, talk or hear
• Occasionally required to stand and reach with hands and arms

Working Environment

• Ability to meet deadlines and attendance standards.
• The noise level in the work environment is usually moderate.
• This classification will be required to sign a confidentiality agreement

Experience, Education and Certifications Required

Experience Required

• 1-3 years claims processing or related service experience
• Dental Assistant education/experience preferred

Required Educational Level

• Requires high school diploma or equivalent.