Dental Appeals Sr. Claims Examiner,

Dental Appeals Sr. Claims Examiner

This position is responsible for the review of dental 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 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 site 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.

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 provide 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.

Must have: High School diploma or GED or minimum Associate degree in lieu of required experience. (Minimum Required) 3 - 5+ Years of 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

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 (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 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.