Remote Government Programs Claims Specialist

Delta Dental Plan of Indiana, Inc.; Okemos, Northern (MI, KY); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401(k) savings plans

Tuition reimbursement

Job summary

Delta Dental of Michigan, Ohio, and Indiana is seeking a Government Programs Professional Review Claims Specialist in Okemos, MI. The role requires coordinating remote work with in-state meetings and training as needed for a distributed team.

Responsibilities include analyzing and processing dental claims, adjudicating per guidelines, and coordinating external consultants. Strong dental terminology knowledge and experience with provider systems are essential.

Qualifications

• Associate's degree or related coursework; two years of chair side assisting experience and RDA/RDH licensure preferred.
• Advanced knowledge of dental terminology and procedures; ability to read radiographs/electronic images.
• Experience with word processing and spreadsheet software; strong verbal and written communication.

Responsibilities

• Analyzes and processes dental claims to finalize determinations following policies and standards.
• Adjudicates claims and maintains claim records per guidelines and contracts.
• Investigates complex provider reconsideration requests and coordinates adjustments.
• Prepares claims for second/third opinions and consults with contracted dentists on cases.
• Performs pre/post-screens and coordinates external dental consultant activities.
• Provides dental policy interpretation and documents testing status for improvements.
• Analyzes data for reports and monitors claims inventory; adjudicates Third Party Liability (COB) recoveries.

Skills

Dental terminology

Claims adjudication

Analytical thinking

Verbal and written communication

Problem solving

Education

Associate's degree or technical/business coursework

RDA or RDH licensure

Tools

Microsoft Word

Excel

Provider system

Job description

Delta Dental of Michigan, Ohio, and Indiana is seeking a Government Programs Professional Review Claims Specialist in Okemos, MI. The role requires coordinating remote work with in-state meetings and training as needed for a distributed team.

Responsibilities include analyzing and processing dental claims, adjudicating per guidelines, and coordinating external consultants. Strong dental terminology knowledge and experience with provider systems are essential.