Dental Claims Review Analyst - Remote

Freddie Mac; New York (NY); Remote; USD 50,000 - 70,000; Full time

Job summary

A leading company in dental insurance services is seeking a skilled professional for claims processing. The role involves analyzing claims, engaging with providers, and investigating member benefits, aiming to improve efficiency and address issues effectively. Ideal candidates should possess a Dental Hygienist certification and relevant experience.

Qualifications

• Dental Hygienist or Claims Coding certification required.
• 2-3+ years of relevant experience in a clinical dental environment.
• Knowledge of claims processing policies and procedures.

Responsibilities

• Analyze and process suspended claims based on clinical guidelines.
• Engage in provider outreach to facilitate claim resolution.
• Investigate member benefits related to claims and grievances.

Skills

Analytical skills

Communication

Problem-solving

Education

Certification as a Dental Hygienist

Bachelor's Degree in a related field

Tools

MS Office Suite

Job description

Employer Industry: Dental Insurance Services

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Utilize specialized knowledge to make a significant impact on claims processing efficiency
- Engage in provider outreach to facilitate claim resolution
- Chance to work closely with dental consultants and directors on escalated claims

What to Expect (Job Responsibilities):
- Analyze and process suspended claims, predetermination, and service requests based on clinical guidelines
- Perform provider outreach and collaborate with dental consultants for claim resolution
- Investigate member benefits and policies related to claims and grievances
- Identify potential fraud patterns and escalate issues to the appropriate teams
- Recommend improvements to enhance system efficiency for dental claims processing

What is Required (Qualifications):
- Certification as a Dental Hygienist or in Claims Coding
- 2-3+ years of relevant experience, including a clinical dental environment
- Knowledge of claim processing policies and procedures
- Proficient in MS Office Suite (Word, Excel, PowerPoint, Outlook, Teams)
- Strong verbal, written, presentation, and interpersonal communication skills

How to Stand Out (Preferred Qualifications):
- Bachelor's Degree in a related field
- Additional specialized training or certifications that may substitute for a Bachelor's degree
- Experience in analyzing dental claim coding issues

#DentalInsurance #ClaimsProcessing #CareerGrowth #ProviderOutreach #FraudDetection

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