Sr. Dental Claims Examiner

This position utilizes a clinical knowledge of dentistry to perform initial screening for dental claims requiring utilization review according to clinical criteria.  This position refers claims to dental consultants for examination when clinical criteria is not met.

 

Position Location: This position is remote and does not require regular in-office presence.

 

What you do:

• Perform initial screening for dental claims requiring utilization review according to clinical criteria.
• Identify dental codes, tooth numbers and relevant procedures to ensure claims are reported appropriately. Review radiographs, periodontal charting, and narratives using dentistry knowledge to verify the submitted procedure.
• Serve as liaison between the customer service/claims department and dental consultants for utilization review process when clinical criteria is not met.
• Evaluate claim discrepancies to ensure claim is processed accurately and make appropriate adjustments. Resolve inquiries and problems and arrive at a quick, accurate, and satisfactory resolution.
• Analyze dental procedure requests in accordance with clinical criteria/guidelines.
• Initiate examinations by dental consultants when procedure requests do not meet clinical criteria.
• Monitor dental provider patterns that are outside of the norm, review utilization management, and educate providers accordingly.
• Apply policy provisions to ensure contractual and legal compliance for guidelines established by various state and federal regulations.
• Contact dental offices to interpret procedures and obtain information and/or supporting documentation.
• Determine areas of development for claims associates as well as system enhancements.

What you bring: 

• Post-secondary training or two years clinical experience either as a Dental Assistant or Dental Hygienist required.
• Must have completed Radiology Training.
• 1-3 years of Dental Assistant, Hygienist or Related Clinical Experience required.
• Insurance industry experience preferred.

What we offer: 

A meaningful mission. Great benefits. A vibrant culture 

Ameritas is an insurance, financial services and employee benefits provider Our purpose is fulfilling life. It means helping all kinds of people, at every age and stage, get more out of life.

 

At Ameritas, you’ll find energizing work challenges. Flexible hybrid work options. Time for family and community. But dig deeper. Benefits at Ameritas cover things you expect -- and things you don’t: 

 

Ameritas Benefits

For your money: 

• 401(k) Retirement Plan with company match and quarterly contribution
• Tuition Reimbursement and Assistance 
• Incentive Program Bonuses 
• Competitive Pay 

For your time: 

• Flexible Hybrid work
• Thrive Days - Personal time off
• Paid time off (PTO)

For your health and well-being: 

• Health Benefits: Medical, Dental, Vision 
• Health Savings Account (HSA) with employer contribution
• Well-being programs with financial rewards
• Employee assistance program (EAP)

For your professional growth: 

• Professional development programs
• Leadership development programs
• Employee resource groups
• StrengthsFinder Program

      For your community:

• Matching donations program
• Paid volunteer time– 8 hours per month

For your family: 

• Generous paid maternity leave and paternity leave
• Fertility, surrogacy and adoption assistance
• Backup child, elder and pet care support

An Equal Oppo