Dental Claims Specialist - 5338

Dental Claims Specialist - 5338

Duration: 5 months (possibility of extension)

Location: Remote

*ERC Required

As a Dental Specialist, you will be responsible for carrying out the claims examination process of dental claims with higher complexity, and providing the team with expert analysis of complicated or unusual claims. The Dental Specialist is responsible for ensuring the accurate and timely processing of complex claims and estimates for reimbursement to our members. This includes assessing dental x-rays and claims, reviewing complex claims for completeness and producing internal and external correspondence. There are clearly defined expectations with regards to service standards, productivity and quality targets and the maintenance of confidential information.

Must Have Skills:

• Experience working in a dental clinic
• Experience reviewing dental x-rays
• Strong knowledge of Group Insurance - Dental claims
• Diploma in Dental Hygiene (CEGEP/College or University)
• HARP certified

Nice To Have

• Bilingualism (French, English, both oral and written)

Responsibilities:

• Review complex claims and estimates for completeness and follow processes for incomplete information on claims
• Assess and adjudicate complex claims and estimates
• Assessing includes studying dental information and plan provisions, researching, documenting results and communicating verbally and or in writing with the client (member/sponsor) to obtain additional details in order to make an informed decision
• Meet production and quality standards set for individuals, teams and department (timeliness, quality and service)
• Handle external and internal inquiries via written correspondence, e-mails and telephone as required
• Participate in departmental projects as required
• Work in conjunction with the Dental Consultant on contentious cases, and with other departments/offices within the company in order to meet customer expectations