Claims Processing Specialist

2 weeks ago


Houston, Texas, United States Ameritas Full time

Position Overview

The Claims Processing Specialist is responsible for managing dental claims by applying claims expertise in line with specific policy and processing protocols. This role serves customers by liaising with providers and insured individuals to effectively assess claims or address general inquiries with minimal supervision.

Key Responsibilities

  • Evaluate and resolve claims that have been rejected by the automated adjudication system, adhering to departmental standards for accuracy and responsiveness.
  • Identify procedure codes, tooth numbers, and their interrelations to ensure proper processing of claims across all product lines, including dental, vision, and hearing.
  • Address inquiries and resolve issues, ensuring prompt and accurate resolutions, including manual processing of claim re-submissions.
  • Understand various contracts and marketing arrangements, including PPO agreements and service guarantees, and interpret coordination of benefits and other policy provisions.
  • Apply policy guidelines and knowledge of company philosophy to ensure compliance with contractual obligations and legal requirements.
  • Conduct secondary reviews of claims.
  • Assist at the front desk, either as the primary contact or as part of a rotation with colleagues.
  • Be prepared to work overtime as necessary based on business demands.
  • Perform additional duties as assigned.

Qualifications

  • High School Diploma or GED is required.
  • 0-2 years of relevant experience is preferred.
  • Experience in a dental-related field or claims processing environment is advantageous.
  • Strong problem-solving and analytical skills are essential.
  • Excellent organizational and time management abilities.
  • Proficient in verbal and written communication, with a focus on clarity and professionalism.
  • Skilled in using personal computer systems and keyboarding.
  • Able to adapt quickly to new procedures and changes in regulations.

Benefits

  • Competitive starting wage.
  • Annual incentive bonus plan.
  • Comprehensive medical, dental, and vision insurance.
  • 401(k) retirement plan with company matching.
  • Generous time off policies.
  • Commitment to employee well-being and community support.
  • Opportunities for professional development and career advancement.
  • Additional benefits including tuition reimbursement and student loan assistance.

Commitment to Diversity

Ameritas is dedicated to fostering an inclusive culture and diverse workplace. We value individual differences and are an Equal Opportunity/Affirmative Action Employer, hiring based on qualifications and work ethic.



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