Claims Examiner II

JOB DESCRIPTION

This position is responsible for reviewing more complex dental, vision and/or other various assigned claim types for accuracy and compliance with group and Delta processing guidelines. The Claims Examiner will also process claims, achieving the minimum acceptable number of claims per day at or above the current acceptable accuracy/quality rates.

RESPONSIBILITIES

• Performs first- and second-level claim review and inputs corrections to enable system adjudication of claims.

• Adjudicates claims in accordance with company and/or regulatory guidelines.

• Collaborates with appropriate department(s) based on company and/or regulatory guidelines to enable accurate claim adjudication.

• Refer escalated claims or process issues to management as appropriate.

QUALIFICATIONS

• 3+ years of experience w/High School

• 2+ years' experience in a similar role; Associate degree preferred. Required to successfully complete level 1 and level 2 training and examinations.

• Analytical, problem solving and reasoning skills; detail orientation.

• Good organizational/time management skills and multi-tasking abilities.

• Ability to work under pressure and meet deadlines.

• Ability to follow verbal and written instructions.

• Ability to effectively communicate problems/questions/explanations.

• Knowledge of Delta Dental systems/organization and knowledge of health care industry issues preferred.

Base Pay Information

The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity. $35,360 - $66,500

ADDITIONAL INFORMATION

Rewards to make you smile! We don't just want to make our customers happy - we want to give our employees a reason to smile, too. Delta Dental's comprehensive benefits package includes:

• Generous paid time off plus 12 holidays and your birthday off!

• Low-cost premium medical insurance options

• 100% paid dental and vision insurance

• Generous 401(k) matching and flat contribution

• Social responsibility and volunteer opportunities, including 16 paid volunteer hours annually

• Employee LiveWell program, focusing on overall employee well-being

• Fertility and diabetes benefits

• Employee discount program: AT&T/Verizon, entertainment, travel, and more!

• Culture of learning: career development and tuition reimbursement

• Career growth: we love promoting from within

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

#LI-Hybrid

ABOUT THE TEAM

At Delta Dental, our success is only as strong as the people who execute it! We take enormous pride in being the nation's most recognized and widely-used provider of dental insurance - and we've come this far by living our core values of innovation, excellence, service and trust. Our vision is to motivate and empower every employee so that we're all inspired to take exceptional care of our customers, providers and ourselves. We believe in integrity, accountability, collaboration, and giving every employee equitable opportunity for their voice to be heard and development to be fostered.

If you're excited about the prospect of transforming the future of health care and growing in your career, join our smile revolution!

To see some of the smiling faces behind Delta Dental and to learn more about what our values and culture look like in action, connect with us on social media: Delta Dental Ins. on Facebook and Instagram, #LifeatDDins on Facebook and Instagram, Delta Dental Ins. on Twitter and Delta Dental Ins. on LinkedIn.

We are part of the Delta Dental Plans Association, a network of companies that provides dental coverage to 74 million people in the U.S. Delta Dental of California, Delta Dental of New York, Inc., Delta Dental of Pennsylvania and Delta Dental Insurance Company, together with our affiliate companies, form one of the nation's largest dental benefits delivery systems, covering 33 million enrollees. All of our companies are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies throughout the country.

Delta Dental is an equal opportunity employer. We are committed to building and maintaining a diverse and inclusive workplace for all employees. Applicants will not be discriminated against because of race, color, religion, creed, national origin, ancestry, citizenship status, sex (including pregnancy), sexual orientation, gender or identity expression, age, disability, marital status, medical status, veteran status or any other status protected under federal, state, or local law. In addition to federal law requirements, Delta Dental complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Unfortunately, our Delta Dental Enterprise is unable to hire individuals residing in Alaska, North Dakota, Nebraska, Hawaii, Oklahoma, Vermont, Maine, West Virginia, New Hampshire, Wyoming, Puerto Rico or other US Territories at this time.

Proof of eligibility to work in the United States must be provided if selected for hire.

Delta Dental* has enacted a COVID-19 vaccination policy to protect all employees and the communities we serve due to the ongoing impacts of the COVID-19 pandemic. Accordingly, we require all employees to be fully vaccinated for COVID-19. Are you able to comply with our policy of being fully vaccinated by your start date if an offer is made or have a medical or sincerely held religious exemption for receiving a COVID-19 vaccine? Failure to comply with our policy and submit proof of compliance or receive approval for a valid medical or sincerely held religious belief exemption prior to your start date will nullify any offer of employment extended to you.

*Delta Dental includes: Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, and Delta Dental of New York

If You Are A Current Employee Click Here To Apply