Claims Examiner

Firstsource; Louisville (KY); On-site; USD 48,000 - 62,000; Full time

Job summary

Delta Dental of Illinois is seeking a Claim Processor/Adjustor in the Claims department. You will process dental claims and troubleshoot inquiries, ensuring accuracy and adherence to business rules.

The role requires strong communication, attention to detail, and the ability to work independently, with a preference for bilingual Spanish candidates. Commitment to high attendance and quality service is expected.

Qualifications

• Excellent oral and written communications skills, strong keyboard skills, knowledge of reimbursement practices.
• Ability to work independently and multitask.
• Excellent attendance and punctuality.

Responsibilities

• Investigate and process claims according to established business rules that have failed computer program edits.
• Provide guidance in claims processing requiring advanced technical and dental knowledge.
• Meet daily/weekly claim production goals as set by the ITL.
• Complete and maintain daily audit production logs.
• Accurately completes special projects assigned within specified time frame.
• Access EPHI following current guidelines as established at company-wide and department levels.
• Maintain regular and punctual attendance.
• Perform other job-related duties as assigned.
• Update ITL or Manager regarding daily status of assigned reports by timeframe established by ITL or Manager.
• Encouraged to work overtime according to business need.
• Accesses EPHI following the current guidelines as established at the company-wide and department levels.
• Maintains regular attendance and punctuality.
• Performs other job-related duties as assigned.

Skills

Communication

Typing

Insurance knowledge

Independent work

Job description

Claim Processor/Adjustor

Reviewed 9.2025

Delta Dental of Illinois

Job Description

JOB TITLE: Claim Processor/Adjustor

DEPARTMENT: Claims

REPORTS TO: Manager, Claims

PAY STATUS: Non-Exempt

OVERVIEW OF POSITION: The Claim Processor/Adjustor is responsible for providing service to the DDIL client base through accurate processing of dental claims as well as troubleshooting and resolving all types of dental claim related inquiries.

DUTIES & RESPONSIBILITIES

• Investigate and process claims according to established business rules that have failed computer program edits
• Provide guidance in claims processing requiring advanced technical and dental knowledge
• Meet daily/weekly claim production goals as set by the ITL
• Complete and maintain daily audit production logs
• Accurately completes special projects assigned within specified time frame
• Access EPHI following the current guidelines as established at the company-wide and department levels.
• Maintain regular and punctual attendance
• Perform other job-related duties as assigned (Professional Review, Appeals Review, E-Forms)
• Update ITL or Manager regarding daily status of assigned reports by timeframe established by ITL or Manager.
• Encouraged to work overtime according to business need.
• Accesses EPHI following the current guidelines as established at the company- wide and department levels.
• Maintains regular attendance and punctuality.
• Performs other job-related duties as assigned.

EXPERIENCE & QUALIFICATIONS

• Excellent oral and written communications skills. Strong computer keyboard skills. Knowledge of insurance reimbursement practices, i.e. processing policies, deductibles, maximums, Coordination of Benefits (COB) and dental terminology.
• Ability to work independently and execute multiple tasks simultaneously
• Excellent attendance and punctuality record.

Additional Preferences

While not a requirement for the position, a preference is given to those who:

• can speak Spanish fluently, or
• can make diagnostic determinations based on provider claim narratives, dental photos and radiographs

Claim Processor/Adjustor

Reviewed 9.2025

Employee Signature Date