Claims Specialist (Dental or Medical)

For more than 45 years, Careington has been a leader in the health and wellness benefits space. Since its founding in 1979, Careington has been delivering dental discount solutions as its core competency. Today, Careington has expanded to offer a growing portfolio of 150+ health, wellness, lifestyle and virtual health products and services designed to deliver cost savings across a spectrum of life needs. Through its affiliated nationally licensed third-party administrator (TPA), Careington also delivers full-scale administrative services, including customer service, licensed enrollment, claims administration, individual and group billing, and more.

Duties And Responsibilities

• Responsible for various dental claims administration duties including but not limited to data entry, scanning of claims, processing and claims payment processing, maintaining claim records, reporting, and researching claim information.
• Monitors and controls backlog and workflow of claims.
• Ensures that claims are settled in a timely fashion and in accordance with turnaround time compliance standard.
• Coordinates with claim vendors and clearinghouses to ensure scanned claims are processed correctly and in a timely manner.
• Makes recommendations for further investigation or resolution of complex claims.
• Reduces defects via pro-active identification of error issues as it relates to pre-payment of claims through adjudication and trends and recommending solutions to resolve these issues.
• Supports all department initiatives in improving overall efficiency.
• Meets department quality and production standards.
• Performs additional duties as required and assigned, including but not limited to special projects as needed.
  
  

Knowledge, Skills, And Abilities

• Claims processing background within medical or dental industry is necessary.
• Extremely organized with the ability to effectively manage multiple tasks.
• Initiative-taking and the ability to work independently with minimal supervision.
• Aptitude to work in a deadline driven environment.
• Ability to communicate clearly, orally and in writing, with the ability to effectively interact with internal and external contacts
• Capability to apply knowledge after training so claims are researched and resolved appropriately.
• Strong work ethic and ability to adapt to new directions as business plans evolve.
• Previous working experience and knowledge of Skygen is preferred.
  
  

Education And Software

• Associate degree or equivalent combination of education and experience.
• Advanced computer skills and experience with MS Applications – Adobe, Excel, Word, Outlook is required.