Responsibilities:
Review, analyze, make appropriate and accurate decisions on dental claims in accordance with policy and state/federal law and regulations. Analyze claim detail and apply knowledge of claims procedures, product design, contract provisions and state and federal regulations to make appropriate, accurate, and timely claim decisions. This includes having a knowledge of plan provisions, determination of eligibility, verification of data input, identification of correct benefit level, coordination of benefits, and corrections.
Qualifications:
- Graduate of life sciences (BDS, MDS, BAMS, BHMS, B Pharmacy, BSc Microbiology, BSc Biotechnology etc) by qualification.
- Minimum of 2-4 years’ experience in medical/dental claims processing, and/or industry courses (i.e., LOMA). Prior claim paying, and/or medical/dental industry experience preferred.
Proficient in MS Office, written and verbal communication skills.
Additional Information:
- Willingness to work in US shift (5:30pm to 2:30am) during the 3-4 months of training period.
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Regular shift time – 1:30pm to 10:30pm in hybrid mode (3 days of working from office per week).
