Claims Analyst: Complex Issues & Payment Accuracy

Delta Dental of Kentucky, Inc; Louisville (KY); On-site; USD 58,000 - 70,000; Full time

Job summary

Delta Dental of Kentucky, Inc. is seeking a Claims Analyst to research and resolve complex claim inquiries, perform adjustments, and collaborate with internal teams to ensure accurate processing in line with benefits and regulations.

A bachelor’s degree in business or healthcare administration and 3–5 years in dental or health insurance claims processing are required, with strong analytical and communication skills; occasional travel may be required.

Qualifications

• Bachelor’s degree in business, healthcare administration, or related field.
• 3–5 years of claims processing or benefits administration experience.
• Strong analytical, research, and problem-solving abilities.
• Excellent written and verbal communication skills.

Responsibilities

• Respond to claim follow-ups and inquiries with clear, accurate resolutions.
• Research complex claim issues by reviewing plans, history, provider information, and guidelines.
• Perform claim adjustments and corrections for accurate payment and explanation of benefits.
• Coordinate with internal departments to troubleshoot issues and coordinate resolutions.
• Track recurring issues, identify trends, and report findings to leadership.
• Ensure compliance with benefit configurations, policies, procedures, and regulations.
• Document research and communications in designated systems.
• Support claim system testing and process changes.
• Maintain current knowledge of processing procedures and system updates.
• Meet quality, productivity, accuracy, and turnaround-time expectations.
• Identify opportunities to improve accuracy and efficiency.
• Perform other duties as assigned.

Skills

Analytical skills

Problem solving

Communication

Attention to detail

Prioritization

Independent judgment

Education

Bachelor's degree in business, healthcare administration, or related field

Tools

Microsoft Office Suite (Outlook, Word, Excel, Teams)

Job description

Delta Dental of Kentucky, Inc. is seeking a Claims Analyst to research and resolve complex claim inquiries, perform adjustments, and collaborate with internal teams to ensure accurate processing in line with benefits and regulations.

A bachelor’s degree in business or healthcare administration and 3–5 years in dental or health insurance claims processing are required, with strong analytical and communication skills; occasional travel may be required.