Our Promise
Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.The Dental Claims Processor is responsible for processing dental claims received from providers and health plan members in accordance with policies, procedures, and guidelines as outlined in Avesis contractual agreements. Claims are processed using Avesis systems and on-line reference resources that specify the details and scope of benefits. The processors’ productive output is guided by performance objectives that specify the volume of claims to be processed on an hourly basis. The Claims Processor must be able to meet accuracy, quality, and productivity standards as determined by Avesis.
Essential Job Functions:
- Understand Avesis’ contracts and performance requirements, claims processing workflow and payment process.
- Resolving escalated claims through research, tracking and trending of issues to improve internal processes by voids, refunds and recoupment.
- Works independently on special projects assigned by Leadership and/or Executive Team.
- Comprehensive knowledge of diagnostic and procedural coding for dental terminology.
- Utilizes resources and critical thinking to analyze complex claims scenarios in an efficient manner, adjust and correct accordingly.
- Apply policies and procedures to confirm that claims meet the criteria for payment as indicated in contractual guidelines.
- Attend and participate in team meetings related to claims processing reviews and updates for company policies and procedures, audit findings, and other related communications.
- Ability to meet or exceed quality, accuracy, and production standards as determined by Avesis.
- Respond to inquiries from customer service team about claims in a 48hr time period.
- Other duties as assigned.
Requirements:
- High School Diploma or GED is required; Associate’s degree preferred.
- Dental claims processing or Dental terminology/knowledge required.
- 1 year claims processing experience preferred.
- Knowledge of Medicare, Medicaid, and Commercial insurance preferred.
- HCPCS, CPT, CDT & ICD 10 coding highly desired.
- Strong skills using Microsoft applications (Adobe, Word, Excel, Etc.) and other windows-based tools.
- Excellent written and verbal communication skills.
- Ability to manage multiple tasks and prioritize work.
- Effective time management and organizational skills.
- Ability to work overtime as needed.
We Offer
- Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
- Competitive compensation package.
- Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
- Life and disability insurance.
- A great 401(k) with company match.
- Tuition assistance, paid parental leave and backup family care.
- Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
- Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
- Employee Resource Groups that advocate for inclusion and diversity in all that we do.
- Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.