Claims Analyst ~ Dental Insurance

Northeast Delta Dental in Concord, NH is looking to hire a hybrid, full-time, Claims Analyst to assure accurate adjudication, refunds, and adjustments of claims by reviewing, researching, and/or returning suspended claims in accordance with appropriate departmental processes.

Do you have the desire to work with a company that values and respects you? Are you ready for a life-changing opportunity? Are you determined to make a smart career move? If so, please read on!

The Claims Analyst position earns a competitive salary at $21.00 - $24.00/hour, depending on experience. We provide fantastic benefits, including health, life, dental, vision, short-term disability (STD), long-term disability (LTD), paid time off (PTO), paid holidays, a 401(k) plan, an independent retirement advisor, an employee assistance program, a tuition reimbursement program, and more! If this sounds like the right business opportunity for you, apply today using our quick, mobile-friendly online application. We hope to meet you soon!

ABOUT NORTHEAST DELTA DENTAL

Northeast Delta Dental - a nonprofit member of Delta Dental Plans Association (DDPA) - is the region's most trusted name in dental insurance for companies, individuals, and families throughout Maine, New Hampshire, and Vermont. We are a values-driven company that successfully balances profitability and community involvement with colleagues working together to create a corporate environment built upon high trust and mutual respect.

A DAY IN THE LIFE OF A DENTAL INSURANCE CLAIMS ANALYST:

Adjudicates claims using Northeast Delta Dental and New England Dental Administrators, LLC, processing policies by reviewing, correcting, editing, and researching suspended claims; contacts dental offices, as necessary, to obtain routine missing information or to correct information. Researches, corrects and processes claims queries.

Processes claims requiring special handling, special consideration, and manual pricing by following the applicable processes noted in the department manual outlined for specific programs/groups/benefits (for example, Ortho, Head Start, Exchanges, New England Dental Administrators, LLC).

Resolves Dental Coordination of Benefits (COB), Dual Delta, and medical claims based on coordination of benefits guidelines; ensures the accuracy of benefits allocation between primary and secondary dental and medical carriers. Updates Subscriber Maintenance module as needed for historical reference.

Calculates refunds for the Customer Service staff, verifies coordination of benefits resolutions and provides information to questions about claims payments.

Responds to claims related inquiries and provides technical information about claims adjudication issues to other Operations staff throughout the company. Refers claims that require special handling to appropriate departmental or interdepartmental resources.

Assures appropriate documentation, X-rays, and/or any applicable notes are attached before forwarding claims to consultant review by reviewing claims and returning claims missing information to the dental offices.

Adjudicates adjustments/supplemental payment claims and refunds/voided check documentation by researching, correcting, and ensuring the accuracy of benefit allocations.

Processes claims suspensions including but not limited to, deleting pre-determinations, history duplications, adjustments, complex group eligibility, history corrections, and other complex suspension issues.

QUALIFICATIONS FOR THIS ROLE:

As a Claims Analyst, you will have an Associate's Degree in Business, Liberal Arts, or related field, and at least two years claims processing or insurance related experience, or an equivalent combination of training, experience, and/or education. Must be proficient in Microsoft Excel and Word.

Must possess thorough knowledge of CDT coding and dental terminology and be able to perform routine mathematical computations and calculations.

WORK SCHEDULE FOR A DENTAL CLAIMS ANALYST

The typical work schedule for this position is Monday - Friday, 8:00 a.m. - 4:00 p.m. This position will train on-premises at our Concord, NH headquarters and then hybrid when appropriate.

**Must be authorized to work for any employer in the United States without sponsorship now and in the future.

Northeast Delta Dental is proud to be an equal opportunity employer.