Claims Specialist

1 week ago

Frisco, United States Careington International Corp Full time

Careington International Corporation is a solutions-oriented company. An established leader, we have been a trailblazer in the field of discount health care since 1979. Over the years, our mission has remained the same — to create discount health programs that are marketable to the employer, profitable to the provider and economical for the member. In response to a growing demand for our products and services in recent years, our growth means that we continuously strive to recruit innovators to join our fast-paced, forward-thinking team.

Careington International is looking to add a new team member to our Dental Claims Administration team.
This position is mainly remote, with office department meetings and/or gatherings each month and quarterly that will take place in Frisco, TX onsite at the Gaylord location.

Duties and Responsibilities:

  • Responsible for various dental claims administration duties including but not limited to data entry, scanning of claims, processing and claims payment processing, maintaining claim records, reporting, and researching claim information.
  • Monitors and controls backlog and workflow of claims.
  • Ensures that claims are settled in a timely fashion and in accordance with turnaround time compliance standard.
  • Coordinates with claim vendors and clearinghouses to ensure scanned claims are processed correctly and in a timely manner.
  • Makes recommendations for further investigation or resolution of complex claims.
  • Reduces defects via pro-active identification of error issues as it relates to pre-payment of claims through adjudication and trends and recommending solutions to resolve these issues.
  • Supports all department initiatives in improving overall efficiency.
  • Meets department quality and production standards.
  • Performs additional duties as required and assigned, including but not limited to special projects as needed.
Knowledge, Skills, and Abilities:
  • Claims processing background within medical or dental industry is necessary.
  • Extremely organized with the ability to effectively manage multiple tasks.
  • Initiative-taking and the ability to work independently with minimal supervision.
  • Aptitude to work in a deadline driven environment.
  • Ability to communicate clearly, orally and in writing, with the ability to effectively interact with internal and external contacts
  • Capability to apply knowledge after training so claims are researched and resolved appropriately.
  • Strong work ethic and ability to adapt to new directions as business plans evolve.
  • Previous working experience and knowledge of Skygen is preferred.
Education and Software:
  • Associate degree or equivalent combination of education and experience.
  • Advanced computer skills and experience with MS Applications – Adobe, Excel, Word, Outlook is required.


Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

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