Dental Claims Specialist

Socket.dev; Winnipeg; On-site; CAD 52,000 - 76,000; Full time

Benefits offered by this job

Competitive starting salary

Health benefit package

Hybrid work environment

Fully equipped onsite fitness center

Casual dress code

Personal and professional development

Job summary

Manitoba Blue Cross is hiring a Dental Claims Specialist to assess, adjudicate and process complex dental claims, pre-authorizations and special coverage claims. You will respond to member and provider inquiries and support dental research and provider relations.

The role requires a Diploma or certificate in Dental Assisting or related field, previous insurance claims experience, and strong communication and organizational skills. Hybrid work and career development opportunities are offered.

Qualifications

• College Diploma/Certificate in Dental Assisting or Business Administration or equivalent combination of education and related experience.
• Previous experience in insurance claims required.
• Strong customer service and professional communication.
• Excellent organizational, analytical and mathematical skills.
• Ability to work under deadlines and both independently and in a team.
• Industry programs include LOMA, CEBS, ICA.

Responsibilities

• Processes complex dental claims and pre-authorizations.
• Assesses and pre-calculates claims with non-standard procedures.
• Reviews pre-authorizations with Dental Consultant and documents status.
• Responds to member inquiries about dental plan coverage.
• Maintains production and supports claims processing efforts.
• Cross trains in Specialist duties as time permits.

Skills

Customer service

Communication

Analytical skills

Organizational skills

Teamwork

Problem solving

Education

College Diploma/Certificate in Dental Assisting or Business Administration

Tools

Word

Excel

Email software

Job description

About Manitoba Blue Cross

We're a Manitoba-based, not-for-profit, health benefits provider with a vision to be the trusted and essential health and wellness partner for all Manitobans. Every dollar made is reinvested in our infrastructure, our people, and our province with the goal of providing better care for our members, expanding our community impact and broadening our health care knowledge.

Why work for us?

Manitoba Blue Cross, is a Manitoba Top Employer. We are empowered to give back to the community, and we know that caring needs to start in our workplace with our own Manitoba Blue Cross team. We actively foster a culture that focuses on your satisfaction, development, diversity, and growth.

Culture of Caring

We strive to succeed at reaching our organizational goals, but we always make time to celebrate our successes. Having fun as a group and rewarding our employees for their accomplishments is an essential part of our workplace culture.

We want our workforce to reflect the diverse community we serve, and we're committed to creating a fair and respectful workplace. We offer a work environment that promotes a healthy work-life balance and support to advance your career that includes:

• Competitive starting salary.
• A comprehensive health benefit package.
• Hybrid work environment, flexible work schedules.
• Fully equipped onsite fitness center.
• Casual dress code to promote diversity and inclusivity.
• Personal and professional development.

Are you a driven, dedicated, and enthusiastic individual who wants to work in a friendly and rewarding environment? If so, we are looking for someone like you! The following position is open to anyone residing in Winnipeg and surrounding areas with valid work authorization.

POSITION SUMMARY:

The Dental Claims Specialist assesses, adjudicates and processes diverse and complex dental claims, pre authorizations and special coverage claims, responds to written and telephone inquiries from members and providers.

DUTIES AND RESPONSIBILITIES

• Processes complex pay member and pay provider dental claims and pre authorizations by on-line entry on the claims system.
• Assesses and pre-calculates claims with non-standard procedures as required.
• Reviews questionable pre-authorizations with Dental Consultant and keeps written record of pre-authorization status when required.
• Responds to members regarding dental plan coverage inquiries and problems.
• Acts as a resource to Benefit Services for Dental research and provider relations research.
• Processes adjustments, corrections and re-adjudication of dental claims and communicates these adjustments to the provider and/or member.
• Adjudicates and assesses out of country dental claims.
• Supports Claims staff in all aspects of Dental claims processing and inquiry.
• Remains abreast of, anticipates and responds positively to changes in industry, product and Dental standards, including recognizing opportunities for process and department improvements. May include participation in Industry working groups and committees.
• Ensures all pended Dental claims are addressed in an accurate and timely manner ensuring proper Workplace management.
• Processes Accidental Dental claims, ensuring proper coordination of benefits across all Dental and Health plans.
• Maintains weekly production report of dental claims processed.
• Assists in processing Dental claims when required.
• Cross trains in all Specialist duties as time permits.
• Performs other related duties as assigned.

SKILLS, QUALIFICATIONS & DESIRABLE ATTRIBUTES

• Dedicated to the principles of exceptional service, committed to responding to, anticipating, and addressing customer needs, for both internal and external customers.
• College Diploma/Certificate in Dental Assisting or Business Administration or equivalent combination of education and related experience.
• Previous experience in insurance claims required.
• Strong customer service skills, ability to communicate effectively with customers and providers in a professional manner.
• Excellent organizational skills with the ability to manage and prioritize several activities on an ongoing basis.
• Strong analytical, problem solving and mathematical skills.
• Exceptional interpersonal and communication skills (verbal and written).
• Strong computer skills including Word, Excel and e-mail software.
• Ability to work efficiently within prescribed time limits and under deadlines.
• Initiative and ability to work independently as well as in a team setting.
• Previous dental office experience is an asset.
• Capable of completing industry education programs entailing a self-directed study and the writing of graded examinations. Specific programs include but are not limited to LOMA, CEBS, and ICA.

To learn more visit: https://www2.mb.bluecross.ca/about-us/careers

We appreciate the interest expressed by all applicants and acknowledge the effort put into the application process, however only those selected for an interview will be contacted.

Manitoba Blue Cross is committed to the principles of diversity, equity & inclusion and to promoting opportunities in hiring for everyone. We want our workforce to reflect the diverse community we serve, and we're committed to creating a fair and respectful workplace.

We encourage all qualified candidates to apply. If you require an accommodation during the hiring process, please let us know.