Health and Dental Claims Analyst

Info Resume Edge; Sharjah; On-site; AED 90,000 - 120,000; Full time

Job summary

A healthcare organization is seeking a Health and Dental Claims Analyst to review and process health and dental insurance claims. The role demands strong analytical skills and detail-oriented mindset. Ideal candidates should possess 13 years of claims processing experience and knowledge of ICD‑10, CPT, ADA codes. Proficiency in claims systems and Microsoft Office is required. This position offers a pivotal role in ensuring compliance and accuracy in claims adjudication.

Qualifications

• 13 years of experience in claims processing for health insurance or dental benefits.
• Knowledge of ICD‑10, CPT, ADA codes and healthcare reimbursement systems.
• Familiarity with healthcare regulations such as HIPAA.

Responsibilities

• Review and analyze incoming health and dental claims for accuracy and eligibility.
• Ensure claims comply with policy coverage terms and regulatory standards.
• Investigate and resolve discrepancies or inconsistencies in submitted claims.
• Apply appropriate fee schedules, adjudication rules, and coding practices.
• Communicate with healthcare providers, policyholders, and internal departments.
• Process approvals or denials in the claims management system.
• Maintain proper documentation and audit trail of claims decisions.
• Monitor and report trends or issues related to claims processing.
• Stay updated with changes in insurance policies, coding, and compliance regulations.
• Support audits, compliance checks, and quality assurance reviews.

Skills

Analytical skills

Attention to detail

Written communication skills

Verbal communication skills

Organizational skills

Education

Bachelor’s degree in Healthcare Administration, Business, or a related field

Tools

Claims adjudication systems

Microsoft Office

Job description

The Health and Dental Claims Analyst is responsible for reviewing, analyzing, and processing health and dental insurance claims. The role ensures that claims are adjudicated accurately and in accordance with policy provisions, guidelines, and regulatory requirements. The ideal candidate will have strong analytical skills, attention to detail, and knowledge of health and dental benefit plans.

Key Responsibilities

• Review and analyze incoming health and dental claims for accuracy and eligibility.
• Ensure claims comply with policy coverage terms and regulatory standards.
• Investigate and resolve discrepancies or inconsistencies in submitted claims.
• Apply appropriate fee schedules, adjudication rules, and coding practices (ICD, CPT, ADA codes).
• Communicate with healthcare providers, policyholders, and internal departments for additional information as needed.
• Process approvals or denials in the claims management system.
• Maintain proper documentation and audit trail of claims decisions.
• Monitor and report trends or issues related to claims processing.
• Stay updated with changes in insurance policies, coding, and compliance regulations.
• Support audits, compliance checks, and quality assurance reviews.

Qualifications

• Bachelor’s degree in Healthcare Administration, Business, or a related field (preferred).
• 13 years of experience in claims processing for health insurance or dental benefits.
• Knowledge of ICD‑10, CPT, ADA codes and healthcare reimbursement systems.
• Familiarity with healthcare regulations such as HIPAA.
• Proficient with claims adjudication systems and Microsoft Office tools.
• Strong attention to detail, analytical, and organizational skills.
• Excellent written and verbal communication skills.