EmblemHealth
Dental Claims Review Analyst
This job is now closed
Job Description
- Req#: 6585
Employer Industry: Dental Services
Why consider this job opportunity:
- Salary up to $77,000
- Opportunity for career advancement and growth within the organization
- Engaging work environment that promotes collaboration and communication
- Chance to utilize clinical expertise in analyzing claims and preventing fraud
- Supportive employer that values professional development and specialized training
What to Expect (Job Responsibilities):
- Analyze and review suspended claims and pre-determinations using clinical expertise and industry standards
- Perform provider outreach to facilitate claim resolution and escalated service requests
- Investigate member benefits and analyze claims, grievances, and appeal cases
- Identify potential fraud patterns and refer them to the appropriate teams for action
- Recommend improvements to the dental claims processing system for increased efficiency
What is Required (Qualifications):
- Bachelor’s Degree
- Certification as Dental Hygienist or Claims Coding
- 2-3+ years of related experience, including experience in a clinical dental environment
- Knowledge of claim processing policies and procedures
- Proficient with MS Office - Word, Excel, PowerPoint, Outlook, Teams, etc.
How to Stand Out (Preferred Qualifications):
- Additional experience, specialized training, or certifications may be considered in lieu of a Bachelor’s degree
- Strong analytical and problem-solving skills
- Exceptional verbal, written, and interpersonal communication skills
#DentalServices #ClaimsProcessing #CareerOpportunity #FraudPrevention #ProfessionalDevelopment
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
EmblemHealth provides all our members the latest plan & health information, including GHI Insurance information. We are dedicated to helping you stay healthy, get well, and live better.
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