Dental Appeals Sr. Claims Examiner,

Dental Appeals Sr. Claims Examiner

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.

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 DENTAL CLAIMS processing experience directly aligned to the specific responsibilities for this role. (Required)

About The Company Lincoln Financial 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 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.