Dental Appeals Sr. Claims Examiner,

Alternate Locations: Charlotte, NC (North Carolina); Dover, NH (New Hampshire); Greensboro, NC (North Carolina); Omaha, NE (Nebraska); Work from Home

Work Arrangement:

Remote : Work at home employee residing outside of a commutable distance to an office location.

Relocation assistance: is not available for this opportunity.

Requisition #: 76033

The Role at a Glance

This position is responsible for the review of denied Dental Claims . You will manage dental claims appeals by providing an independent review of the facts and circumstances, within the state and federal regulations including ERISA/DOL. In this role, you will act on new dental claim appeals within 5 business days, and render appeal decisions within 15 days for pre-service, and 30 days for post-service. Written communication of appeal upholds will be clear and concise, and siting policy and decision rationale in clear, easy to understand terms. You will partner with other departments, such as Enrollments and DentalConnect as needed, while adhering to PHI. Read on!

What you'll be doing

• You will analyze & process claims by investigating information. Apply claim policies & procedures and engages intervention of internal/external resources to ensure fair, ethical, & timely management of assigned claims.
• You will analyze and interpret complex coverage contracts to determine if eligibility is met.
• You will liaise with various stakeholders from across the business (Enrollments, DentalConnect) to obtain needed information to clarify and address issues.
• You will rovide customers with explanations of policy details and claim determination.
• You will effectively utilize and implement policies & procedures regarding overall claims workflow.
• You will propose and develop practices & processes to improve performance and the customer experience.
• You will work as an individual and part of a team to ensure all new appeal assignments are acted on within department turnaround times.

What we're looking for

Must have:

• High School diploma or GED or minimum Associate degree in lieu of required experience. (Minimum Required)
• 3 - 5+ Years of DENTAL CLAIMS processing experience directly aligned to the specific responsibilities for this role. (Required)

Nice to haves:.

• 3-5 years experience processing dental claims.
• Understand dental medical terms, records and test results.
• Ability to read, analyze and interpret Dental policies.
• Demonstrate strong written and verbal communication.
• Ability to work with others in a team environment.
• Demonstrates excellent organizational skills with the ability to prioritize workload and multi-task while maintaining strict attention to detail.
• Demonstrates strong interpersonal skills with a collaborative style.
• Demonstrates the ability to use sound judgment and discretion regarding confidential information

Application Deadline

What's it like to work here?

At Lincoln Financial, we love what we do. We make meaningful contributions each and every day to empower our customers to take charge of their lives. Working alongside dedicated and talented colleagues, we build fulfilling careers and stronger communities through a company that values our unique perspectives, insights and contributions and invests in programs that empower each of us to take charge of our own future.


What's in it for you:

• Clearly defined career tracks and job levels, along with associated behaviors for each of Lincoln's core values and leadership attributes
• Leadership development and virtual training opportunities
• PTO/parental leave
• Competitive 401K and employee benefits
• Free financial counseling, health coaching and employee assistance program
• Tuition assistance program
• Work arrangements that work for you
• Effective productivity/technology tools and training

The pay range for this position is $25.87 - $30.34 with anticipated pay for new hires between the minimum and midpoint of the range and could vary above and below the listed range as permitted by applicable law. Pay is based on non-discriminatory factors including but not limited to work experience, education, location, licensure requirements, proficiency and qualifications required for the role. The base pay is just one component of Lincoln's total rewards package for employees. In addition, the role may be eligible for the Annual Incentive Program, which is discretionary and based on the performance of the company, business unit and individual. Other rewards may include long-term incentives, sales incentives and Lincoln's standard benefits package.

About The Company

Lincoln Financial (NYSE: LNC) helps people to confidently plan for their version of a successful future. We focus on identifying a clear path to financial security, with products including annuities, life insurance, group protection, and retirement plan services.


With our 120-year track record of expertise and integrity, millions of customers trust our solutions and service to help put their goals in reach.


Lincoln Financial Distributors, a broker-dealer, is the wholesale distribution organization of Lincoln Financial. Lincoln Financial is the marketing name for Lincoln Financial Corporation and its affiliates including The Lincoln National Life Insurance Company, Fort Wayne, IN, and Lincoln Life & Annuity Company of New York, Syracuse, NY. Lincoln Financial affiliates, their distributors, and their respective employees, representatives and/or insurance agents do not provide tax, accounting or legal advice.


Lincoln is committed to creating an inclusive environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.


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Be Aware of Fraudulent Recruiting Activities

If you are interested in a career at Lincoln, we encourage you to review our current openings and apply on our website. Lincoln values the privacy and security of every applicant and urges all applicants to diligently protect their sensitive personal information from scams targeting job seekers. These scams can take many forms including fake employment applications, bogus interviews and falsified offer letters.

Lincoln will not ask applicants to provide their social security numbers, date of birth, bank account information or other sensitive information in job applications. Additionally, our recruiters do not communicate with applicants through free e-mail accounts (Gmail, Yahoo, Hotmail) or conduct interviews utilizing video chat rooms. We will never ask applicants to provide payment during the hiring process or extend an offer without conducting a phone, live video or in-person interview. Please contact Lincoln's fraud team at View email address on click.appcast.io if you encounter a recruiter or see a job opportunity that seems suspicious.

Additional Information

This position may be subject to Lincoln's Political Contribution Policy. An offer of employment may be contingent upon disclosing to Lincoln the details of certain political contributions. Lincoln may decline to extend an offer or terminate employment for this role if it determines political contributions made could have an adverse impact on Lincoln's current or future business interests, misrepresentations were made, or for failure to fully disclose applicable political contributions and or fundraising activities.

Any unsolicited resumes or candidate profiles submitted through our web site or to personal e-mail accounts of employees of Lincoln Financial are considered property of Lincoln Financial and are not subject to payment of agency fees.

Lincoln Financial ("Lincoln" or "the Company") is an Equal Opportunity employer and, as such, is committed in policy and practice to recruit, hire, compensate, train and promote, in all job classifications, without regard to race, color, religion, sex, age, national origin or disability. Opportunities throughout Lincoln are available to employees and applicants are evaluated on the basis of job qualifications. If you are a person with a disability that impedes your ability to express your interest for a position through our online application process, or require TTY/TDD assistance, contact us by calling View phone number on click.appcast.io.

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