Claims Specialist I

Location: Remote/Hybrid opportunities available depending on proximity to headquarters in Indianapolis.

About the role

As a Dental Claims Specialist at Renaissance, you will analyze and adjudicate claims to ensure accurate benefits administration.

Responsibilities

• Accurately analyze and process dental claims to finalize appropriate determinations with correct procedures, policies, and bypasses.
• Administer claim processing guidelines/standards, Renaissance processing policies, group contracts, provider agreements, and state laws applicable to claims adjudication.
• Review all submitted information to ensure accurate processing of dental claims, including interpretation of radiographs, periodontal charts, and chart notes.
• Review and prepare orthodontics and complex service claims for processing.
• Perform manual entry of claims that failed EDI transmission.
• Maintain related departmental documents and provide interpretation of processing guidelines to internal and external contacts.
• Other responsibilities as assigned by department supervisor.

Requirements

• High school diploma or equivalent; minimum of one-year dental insurance processing experience is preferred (other medical insurance experience may be accepted).
• Knowledge of dental terminology and dental procedures, with the ability to read and interpret radiographs, electronic images, and photos.
• Effective verbal and written communication skills.
• Ability to resolve complex problems and use independent judgment.
• Any suitable combination of education, training, or experience will be considered.

Pay

$22.00–$24.00/hour