Dental Claims Adjuster

SUMMARY: The Dental Claims Adjuster is responsible for timely and accurate processing of dental and orthodontic claims for the Plan’s participants, complying with the plan’s written provisions and the Fund’s administrative policies and procedures. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. Handle all general telephone and walk-in inquires including but not limited to status, complaints, eligibility, benefits, etc. Adjudicate routine dental and orthodontic claims and all associated tasks in accordance with the Plan, regulatory and contractual guidelines. Maintain current department knowledge of plan documents, summaries of plan provisions and other plan materials. Meet or exceed established department production and quality standards on a weekly, monthly, quarterly and annual basis. Proactively identify opportunities for improvement. Actively participant in system testing when needed. Handle all duties and assignments in a timely manner. Perform other job related duties/special projects as assigned. Abide by organizational and HIPAA guidelines, privacy practices, and confidentiality. Comply with the policies of the Trust Fund, as set forth in the Employee Handbook. Adhere to the company’s attendance policy. QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including regular and consistent attendance. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION and/or EXPERIENCE: High School diploma or GED required Registered Dental Assistant (RDA) License preferred 2-3 years of previous work experience in dental claims processing Working knowledge of dental procedure codes (CDT) and claims terminology Able to utilize MS Office (Excel, Word and Outlook) proficiency required Exceptional customer service skills with the ability to build rapport with the Plan participants, team members and other employees of the Fund