Claims Specialist I

Claims Specialist I

Renaissance Benefits is hiring for a Dental Claims Specialist!

At Renaissance, the Dental Claims Specialist analyzes and adjudicates claims to ensure accurate benefits administration.

What will this role entail?

• Accurately analyzes and processes dental claims so appropriate determinations can be finalized with correct procedures, policies, and bypasses.
• Administers claim processing guidelines/standards, Renaissance processing policies, group contracts, provider agreements, and state laws applicable to claims adjudication.
• Reviews all information submitted to ensure accurate processing of dental claims including interpretation of radiographs, periodontal charts, and chart notes.
• Reviews and prepares orthodontics and complex service claims for processing.
• Performs manual entry of claims that failed EDI transmission.
• Maintains related departmental documents and provides interpretation of processing guidelines to internal and external contacts.
• Other responsibilities as assigned by department Supervisor.

Minimum Requirements:

• High school diploma or equivalent; minimum of one year dental insurance processing experience is preferred; will accept other medical insurance experience.
• Knowledge of dental terminology and dental procedures and the ability to read and interpret radiographs, electronic images and photos.
• Effective verbal and written communication skills.
• Ability to resolve complex problems and use independent judgment.
• Will accept any suitable combination of education, training, or experience.

Pay Range: $22.00-24.00/hour

The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.