Dental Claims Approver III

Description and Requirements
Job Responsibilities

• Scrutinizing dental claim documents & settlements
• Process claims as per the set healthcare guidelines
• Follow HIPAA guidelines
• Accurate processing of Dental claims and meeting productivity targets
• Good understanding of Claims adjudication fundamentals
• Good understanding of ICT & CPT Codes
• Knowledge of policy concepts like Deductible, coinsurance, copay, out of pocket
• Able to learn, adapt, implement process guideline into practice, work as a natural team-player in the process
• Handle escalations
• Need to ensure quality and productivity targets are met
• Ensure compliance with internal policies and procedures, external regulations and information security standards

Knowledge, Skills and Abilities
Education

• Bachelor's degree (Any Stream) or diploma with a minimum of 15 years of education

Experience

• 2 years of work experience in US Health Claims processing preferably in claims adjudication

Knowledge and skills (general and technical)
Technical Skills

• Computer navigation skills
• Keyboarding and data entry speed (minimum 30 wpm with 90% accuracy)
• Working knowledge of MS Excel and MS Word.
• Process Specific Skills
• Knowledge of Insurance principles in relation to the US Insurance industry
• Knowledge about US Culture
• Knowledge of Dental claims terminologies and processes will be an added advantage

Soft Skills

• Strong organizational skills
• Good communication skills
• Demonstrate ability to work independently and in a team environment
• Self-disciplined and results oriented
• Ability to multi task
• Strong understanding and comprehension of the English language
• Good PC skills
• Attention to detail
• Team player
• Positive attitude

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