Claims Processing Specialist at Delta Dental of California in rancho cordova, California

Job Description:

At Delta Dental, our strategy is only as strong as the people who execute it! We are hiring individuals that are not just right for today but also for our future. We have built a foundation of high-trust by treating all people with dignity, making and keeping commitments, and consistently striving to do the right thing. Our leaders optimistically share future possibilities to inspire and motivate others toward their full potential. We expect our employees to find ways to embrace positive change, be curious and challenge the status quo, and provide solutions to unmet problems. Joining Delta Dental means joining a culture focused on fostering development, building genuine connections, recognizing each other's strengths and sharing in successes.
The incumbent in this role identifies and provides solutions for processing unique claims, refunds, overpayments and underpayments. Other duties include processing special claims including manual review of treatment compared to authorized treatment, and adjudicating VA CCN claims.

How you will make an impact:

• Analyzes submitted authorizations in comparison to submitted claims.


• Processes special claims payments for VA CCN client.


• Processes returned Delta Dental checks, personal checks, undeliverable checks, stale dated checks, and requests for voids/stop-payments/re-issues. Determines refund amounts and updates the status of outstanding overpayments.


• Reviews monthly reports for outstanding overpayments and coordinates with finance on special issues.


• Handles special professional reviews and service issues, quality complaints and coordinates with Special Correspondence Unit.


• Performs miscellaneous duties as assigned.

What we look for:

• Claims adjudication and customer service experience including the understanding of re-adjudication is preferred.


• Ability to collaborate effectively with others.


• Two or more years as dental paraprofessional preferred.


• Strong analytical, organizational and multi-tasking skills.


• Detail oriented, flexible and creative.


• Excellent customer service skills with ability to evaluate and respond to contact needs.


• Ability to independently prioritize work and establish, understand and follow work rules and procedures, and take action to improve existing processes.


• Ability to confront difficult situations and make appropriate and timely decisions.


• Ability to follow-up on commitments on a timely basis, adhere to deadlines, and be a strong team player.


• Basic knowledge of accounting principles.


• Knowledge of Enterprise policies, procedures and guidelines.

Benefits and perks:

• 12 days starting vacation plus 12 holidays and your birthday off!


• Multiple medical insurance options: 100% paid or low cost premiums


• 100% paid dental insurance


• 100% paid vision insurance


• Employee well-being program


• Culture of learning: substantial tuition reimbursement to improve your skills


• Career growth: we love promoting from within


• Strong commitment to work/life balance


• Social responsibility and volunteer opportunities

Please note, Delta Dental will not sponsor applicants for work visas for this position.
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At Delta Dental we:Promote accountability, integrity and collaboration: Our employees are collaborative, self-aware, and ethical. It is our expectation to do the right thing and follow through on commitments.Foster professional development: Our employees take ownership of developing themselves and others through coaching, mentoring and providing/being open to constructive feedback and identifying learning opportunities.Value customers and cultivate positive experiences: Our employees take time to build rapport with customers, while anticipating and exceeding their needs to ensure positive outcomes.
If you think this sounds like you, let's chat. We would love to tell you more!
To see some of the smiling faces behind Delta Dental and to learn more about what our values and culture look like in action, connect with us on social media: @lifeatddins on Facebook and Instagram, @deltadentalins on Twitter, and Delta Dental Ins. on LinkedIn. ABOUT Delta DentalDelta Dental covers more Americans than any other dental benefits provider. Our vision is to motivate and empower every employee so we're all inspired to take exceptional care of our customers, providers and each other. Our Enterprise Strategy focuses on pillars of Growth and Diversification, supported by the platforms of Culture and People, Process and Technology. Our employees take pride working for a purpose-driven organization and live our values of Trust, Service, Excellence and Innovation. We are part of the Delta Dental Plans Association, a network of companies that provides dental coverage to 74 million people in the U.S. Delta Dental of California, Delta Dental of New York, Inc., Delta Dental of Pennsylvania and Delta Dental Insurance Company, together with our affiliate companies, form one of the nation's largest dental benefits delivery systems, covering 33 million enrollees. All of our companies are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies throughout the country.Delta Dental provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other classification protected by federal or state law. In addition to federal law requirements, Delta Dental complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Proof of eligibility to work in the United States must be provided if selected for hire. Apply Now