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 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 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. 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. Nearest Major Market: Omaha Nearest Secondary Market: Council Bluffs #J-18808-Ljbffr