Claims Examiner

Join Delta Dental of Oklahoma, the leading dental benefits provider in the state of Oklahoma.

This position will work 40 hours per week.

Equal Opportunity Employer - Minority / Female / Disability / Veteran

DUTIES :

This position will be responsible for reviewing radiographs, narratives and periodontal charting in order to process and pay / deny claims and predeterminations within the delegated authority level, based on DDOK CDT guidelines. Communicate and work closely with the dental consultants on claims which require consultant review and process those claims based on consultant determination. Contact providers and assist with incoming provider calls when additional information is needed or clarification required. This position is also responsible for maintaining assigned workflow queues and ensuring all claims are processed within set Standards of Performance.

QUALIFICATIONS :

• High School Diploma or equivalent.
• Three (3) or more years of chairside dental assistant experience or Certified Dental Assistant.
• Ability to data enter 4500 KSPH alpha & 5000 KSPH numeric.
• A thorough understanding of dental procedure codes and dental terminology.
• Must be able to determine correct procedure benefit and qualifications when reviewing documentation and / or dental radiographs that have been submitted with all claims and predeterminations.
• Ability to view radiographic images with accuracy.
• Working knowledge of Microsoft Word, Outlook, and Excel.

ADDITIONAL QUALIFICATIONS FOR CONSIDERATION :