Claim Processor Work from home

Job Description Delta Dental of Missouri is looking for a sharp, organized, and motivated Claims Processing Representative I to join our team. In this role, you'll independently process dental claims, investigate eligibility issues, and ensure accuracy across a variety of claim types. Apply now to help us deliver accuracy and excellence in every claim.
The primary responsibility of the Claims Processing Representative I is to independently process claims of low to moderate complexity. This role researches and investigates claims issues including eligibility denials, provider suspensions, and student eligibility decisions to completion when possible. This position resolves specialty claims or processes with low to moderate complexity and may leverage knowledge and skills to resolve complex claims in a single specialty or process area.
This position may escalate complex claims issues to next level roles when needed.
Processes claims of low to moderate complexity across a variety of claims types. Researching and investigating claims issues;

• Reviewing guidelines to understand protocols, policies and procedures;
• Documenting decisions and relevant information to ensure thorough information for future reviews;
• Researching details related to all aspects of the claim to ensure compliance with all relevant policies and laws;
• Utilizing a thorough understanding of claims policies and protocols to research and resolve exceptions;
• Determining appropriate pricing and resubmits claims for processing by next level roles when needed;
• Meeting or exceeding key metrics as outlined in individual goals provided to you in writing by your team lead;
• Participate in in-person meetings to learn new skills, train on system updates, build and maintain general knowledge and skills to help customers, stay abreast of departmental and organizational updates, engage in team building, maintain company culture, and foster relationships and build camaraderie with coworkers.

Resolves claims of low to high complexity across a single specialty or process area. Resolving exceptions assigned to specialty claims or processes including foreign, implants, coordination of benefits, orthodontic, recovery and utilization management;

• Utilizing a thorough understanding of claims policies and protocols to research and resolve exceptions;
• Responds to emails, follows up and other forms of communication with other departments on outstanding claims issues requiring further intervention. Providing external outreach as needed to providers and members;
• Responding to claims processing emails as part of a regular rotation.

Documenting outcomes of all tasks as appropriate;
• Providing external outreach as needed to providers and members.
Minimum of 3 years’ experience in the dental industry or claims processing role preferred;

• Knowledge and experience in benefit determination and dental terminology preferred;
• Detail-oriented with a commitment to accurate and efficient claims processing.

Quality focused
• This position currently functions as a hybrid role working from both home and in-office environments. Any home office setting must be conducive to all guidelines outlined by the organization. The employee is frequently required to use hands and arms to handle, feel, reach and operate a computer. This job requires substantial typing.
Additionally, this position requires working in a fast-paced environment that can be stressful at times based on the high volume of claims.
The ability to move from claim to claim in rapid succession is required.
This position requires a substantial amount of multi-tasking and ability to shift focus between tasks, screens, and systems to obtain data.
DDMO provides reasonable accommodation to qualified individuals with a known disability unless doing so imposes an undue hardship.