Claims Service Specialist
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Location:
Arlington, VA, US
Company:
Dominion National
Summary:
The Claims Service Specialist investigates, determines liability, and resolves dental claims to ensure accurate processing and resolution of inquiries. They are responsible for reviewing submitted claims for proper filing procedures and maintaining compliance with department guidelines.
Requirements:
Hard Skills: Claims processing, Dental terminology, Microsoft office suite, Excel, Outlook, Problem solving, Analytical skills, Project management, Communication skills, Organizational ability, Time management, Liability determination, COB claims, Data entry
Experience: 2-5 years
Job Description:
Position Description
Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Dominion National at the time of posting and may be modified in the future. Dominion National offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.
Dominion National, a rapidly growing and leading provider of dental and vision benefits, has an exciting opportunity for an experienced Claims Service Specialist.
The Claims Specialist will investigate claims, determine liability, and review information related to claims to ensure resolution of claims concerns and inquiries. The Claims Specialist is also responsible for reviewing dental claims after they are submitted to make sure that the proper filing procedures have been followed.
Responsibilities and Qualifications
- Process claims accurately in accordance with the claims processing system and other department guidelines.
- Investigate and resolve claim concerns; reverse and reprocess claims as necessary.
- Respond to specialized claims inquiries from patients and providers.
- Determine liability as it relates to COB claims.
- Review provider and/or member status to determine eligibility, participation, primacy, and correct reimbursement level, which may include re-pricing.
- Ensure that appropriate follow-up to claims inquiries/requests is complete and timely.
- Maintain current knowledge of Claims policies and procedures.
- Perform other work-related duties as assigned.
Skills:
- Able to handle multiple tasks simultaneously, meet time sensitive deadlines and organize workload with general supervision.
- Knowledge of Dental Terminology (preferred).
- Intermediate experience with Microsoft Office Suite, including Excel and Outlook.
- Skills needed: Strong problem, analytical, project management, well-developed communication skills and organizational ability. Able to meet deadlines.
Experience:
- Minimum two years in dental or claims experience, to include claims processing.
Education and Certifications:
- High school diploma or equivalent (required)
- Associate degree (preferred).
Physical Demands:
- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
- While performing the duties of this job, the employee is regularly required to talk or hear.
- The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.
