Dental Claims Adjudication Specialist

NationsBenefits, LLC; Plantation (FL); On-site; USD 42,000 - 56,000; Full time

Job summary

NationsBenefits, LLC in Plantation, FL is seeking a Claims Processor to adjudicate dental claims for roughly 400,000 members. You will review, price, and pay or deny claims in line with plan benefits, state regulations, and company policy.

You will route cases to clinical review when needed, handle adjustments and refunds, respond to inquiries, and maintain HIPAA-compliant documentation. This role requires attention to detail, time management, and teamwork with Fluent and internal partners.

Qualifications

• 2+ years of dental or health insurance claims processing experience.
• Working knowledge of CDT codes, dental terminology, EOBs, and coordination of benefits.
• Proficient in data entry with strong attention to detail.
• Ability to meet productivity and accuracy standards (e.g., 98% financial and 95% procedural accuracy).
• Proficient in Microsoft Office; comfortable with multiple systems and imaging viewers.

Responsibilities

• Adjudicate dental claims (ADA/CDT coded) from work queues, applying member benefits, fee schedules, frequency and age limitations, waiting periods, deductibles, maximums, and COB.
• Review pended claims, attachments, narratives and x-rays for completeness and identify claims requiring clinical review.
• Refer claims to the hygienist team or to Fluent for clinical recommendations, then apply the recommendation correctly and document the outcome.
• Process adjustments, reprocessing, refunds, overpayment recoveries, and corrected claims.
• Research and resolve claim inquiries from Customer Service, providers, and members; document actions clearly in the claim notes.
• Meet daily productivity, quality, and turnaround targets, including state prompt-pay timelines.
• Identify trends, system errors, and benefit configuration issues and escalate to leadership.
• Protect PHI and follow HIPAA, privacy and compliance requirements at all times.
• Participate in training, quality audits, and user acceptance testing ahead of go-live.

Skills

Dental claims processing

CDT codes knowledge

Data entry accuracy

Microsoft Office

Education

High school diploma or equivalent

Associate or Bachelor's degree preferred

Tools

Microsoft Office

Job description

NationsBenefits, LLC in Plantation, FL is seeking a Claims Processor to adjudicate dental claims for roughly 400,000 members. You will review, price, and pay or deny claims in line with plan benefits, state regulations, and company policy.

You will route cases to clinical review when needed, handle adjustments and refunds, respond to inquiries, and maintain HIPAA-compliant documentation. This role requires attention to detail, time management, and teamwork with Fluent and internal partners.