Claim Administrator

Location: Boston, Massachusetts, United States

Notice

This position is no longer open.

Remote Opportunity: 0

Requisition Number: 3537

Position Title: Claim Administrator

External Description:

Claim Administrators may specialize in one or more of DentaQuest’s business units and are responsible for the highest level of processing. Claim Administrators must use independent judgment and prior experience to accurately post refund checks, process complex follow ups that could not be resolved elsewhere and adjust claims to a final resolution. Accuracy of 99% or higher is required.    

PRIMARY JOB RESPONSIBILITIES:

  • Consistently process advanced & complex claim adjustments with a 99% or greater accuracy rate.
  • Uses business knowledge to independently resolve advanced claim adjustment scenarios including, but not limited to, refunds, corrections, follow ups, coordination of benefits, orthodontia, check returns, retention and all outstanding claim issues.
  • Responsible for the adjustments to complex claims as necessary to meet corporate goals.
  • Document work product and track outstanding items and turnaround times within Windward or other manual tracking tools such as excel spreadsheets.
  • Work closely with providers, members and clients to properly resolve claim issues.
  • Collaborate with members of sales, client services and provider relations to address outstanding claim issues.
  • Communicate with leadership on claim trends to assist in proactively resolving broader claim issues.
  • Work with management to increase auto adjudication rates and self-service utilization.
  • Process map workflow and lead resolution of ad hoc scenarios.
  • May serve as back up to call center during peak periods by taking provider and member calls to ensure corporate wide service levels are consistently achieved.
  • Serve as back up to Claim Research and Resolution team by researching and resolving claim issues
  • Other duties as needed or required. 

Required:

  • Associates degree and/or six years’ experience in a business environment.
  • Strong math competency.
  • Previous claim processing experience required.
  • Attention to detail, accuracy and organization skills are essential.
  • Understanding of general insurance principles.
  • Independent and strategic decision making.
  • Strong interpersonal, written and verbal communication skills.
  • Self-motivation demonstrated by taking initiative to learn more and assume on more challenges.
  • Cooperative, professional and effective interaction skills with co-workers, business partners and visitors.
  • Ability to work in excess of 40 hours in a week.
  • Ability to efficiently operate computer.
  • Ability to use Microsoft Office. (Word, Excel and Outlook)
  • Able to follow verbal and written instructions.
  • Ability to read and comprehend at a high school level.
  • Ability to communicate in an active office environment.
  • Ability to sit for more than 90% of an 8 hour day.
  • Ability to use basic office equipment and communicate via telephone or computer technology, by way of written and verbal channels.

PHYSICAL DEMANDS:

  • Ability to communicate in an active office environment.
  • Ability to efficiently operate all job-related office equipment.
  • Ability to communicate via telephone.
  • Ability to sit for 80% or more of an 8-hour workday.
  • Ability to read and view a computer screen.
  • The office environment is active with high voice levels and interruptions that may challenge hearing and concentration.

City: Boston

State: Massachusetts

Community / Marketing Title: Claim Administrator

Company Profile:

We believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.

Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it. 

To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.

The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.

Company Profile Job:

Location_formattedLocationLong: Boston, Massachusetts US

CountryEEOText_Description: In accordance with our Compliance Plan, employees must conduct business in accordance with applicable laws, regulations, professional standards and ethical standards and report potential compliance or ethical issues to manager or Compliance Officer. Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please see Human Resources for additional information regarding this Program. Equal Employment Opportunity Statement: We are committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, or sexual orientation.

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