Claims Examiner 1 Jobs (NOW HIRING)

Position Summary

Our Claims Examiners are provided with established company guidelines and examine and adjudicate dental claims using these guidelines, with expected levels of quality and productivity.  

This is a full-time hybrid position, Monday through Friday, 8 am to 4:30 pm, working in the office Tuesday and Wednesday, and remote Monday, Thursday and Friday. During the first five weeks, you will attend full-time paid training which follows the same hybrid schedule. This position starts at $22.05 per hour and is benefits eligible.  

Essential Functions & Responsibilities

• Accesses systems and keys claim data and other information and notations from work queues. Suspends, routes and adjudicates claims and performs research as required. Also, inputs fee filing data, as required
• Creates and processes claims for pre-treatment estimates with payments.
• Maintains and updates subscribers files with information obtained through inquiries and submitted claims and documents, i.e., family on hold codes applied or removed, student status deferred, addresses updated. Reports file discrepancies to management.
• Responsible for researching and retrieving all documentation and resolving all claims in question, including student documentation, provider research, some coordination of benefits, diagnostics materials, etc.
• Understand system rejects and applies appropriate RFS codes as well as processing policies on applicable claims.
• Requests information from providers and subscribers through telephone contact or written correspondence.
• Resolves claims related system generated error and adjustment reports.
• Supports and participates in completing claims related projects.
• Acquire necessary skills through in-house training for Claim Examiner II position. Achieve Level II position within 36 months from start of Claims Examiner I.
• When necessary, refers inquiries to management, dental consultants or appropriate outside organizations.
• Provides management with required production figures as requested.
• Other duties as assigned

Essential Qualifications

Competencies

Adaptability-Flexibility

Communication Skills

Computer Skills

Customer Focus

Dependability

Job Knowledge

Productivity

Quality

Teamwork

Knowledge, Skills & Abilities

Technical and Functional

• Personal computer skills with the ability to type 25 words per minute
• Possess the ability to use Microsoft Word and Excel
• Excellent written and oral communication skills
• Ability to research and troubleshoot problems
• Demonstrate good analytical and proofreading skills
• Attention to detail
• Good organizational skills

Key Performance Indicators

• Meet-exceed CPH of 30 or above
• Maintain TQM of 99% or higher

Required Physical Abilities

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to sit and perform extensive close keyboard and PC work
• Ability to walk, talk or hear
• Occasionally required to stand and reach with hands and arms

Working Environment

• Ability to meet deadlines and attendance standards.
• The noise level in the work environment is usually moderate.
• This classification will be required to sign a confidentiality agreement.

Experience, Education and Certifications Required

Experience Required

• 1-3 years claims processing or related service experience
• Dental Assistant education/experience preferred

Required Educational Level

• Requires high school diploma or equivalent.

Other Certification

• n/a

About Delta Dental of New Jersey & Connecticut
Delta Dental of New Jersey, Inc. is New Jersey's leading dental benefits company, providing or administering coverage to more than 2.2 million people through contracts with groups and individuals in New Jersey and Connecticut. In Connecticut, Delta Dental of Connecticut, Inc. is a licensed insurer that writes dental and vision coverage on an insured basis, and Delta Dental of New Jersey administers self-funded dental benefit programs.
Offering dental benefits since 1969, Delta Dental of New Jersey's mission is to promote oral health to the greatest number of people by providing accessible dental benefit programs of the highest quality, service, and value. Through its philanthropic arm, the Delta Dental of New Jersey Foundation awards more than $1M in grants annually to support access to dental care and education for underserved children, seniors, veterans, and those with special needs, as well as funds workforce development programs for dental assisting and dental hygiene across New Jersey and Connecticut.
Benefits
In addition to a great culture, we offer excellent benefits including medical, dental, vision, life insurance, short and long-term disability, spending accounts, and matching 401k. We value our associates and support everyone with learning and development, recognition programs, active wellness and diversity initiatives, tuition reimbursement, and generous paid time off to recharge – even paid time off to volunteer at causes that you care about.
The benefits set forth in this posting reflect DDNJ's benefits policies in place at the time of posting, as are made available to other similarly situated employees of DDNJ, although participation is at all times in accordance with and subject to the eligibility and other provisions of such plans and programs. DDNJ reserves the right, in its sole discretion, to prospectively modify or terminate any of its benefits plans or programs at any time and for any reason, to the extent permitted by applicable law. DDNJ complies with all applicable state and federal wage and hour, pay equity and pay transparency laws.
Primary Location Full Time Salary Range
In addition to salary, Delta Denta of New Jersey's offerings may also include, for eligible employees, discretionary and formulaic incentive awards. Available offerings may vary by geographic location, job level, skills, experience, qualifications, education and date of hire.
Delta Dental of New Jersey Inc is an equal opportunity employer
All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, ancestry, sex, sexual orientation, gender identity, national origin, genetics, disability, marital status, age, veteran status, domestic partner status, medical condition or any other characteristic protected by law.