Dental Claims Support I

About the position

The Dental Claims Support I position at Moda Health is a full-time role focused on providing essential support in processing complex dental claims and adjustments. This hybrid position involves investigating claims, coordinating benefits, and ensuring compliance with internal procedures and guidelines. The role requires strong communication skills and the ability to manage multiple tasks effectively while maintaining high standards of accuracy and quality.

Responsibilities
? Provide backup support to leads, including training of staff.
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? Investigate complex file reviews and process complex claims adjustments and Coordination of Benefits (COB) claims.
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? Sort, assign, and work various reports such as building member accumulators and giving deductible credits.
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? Adjust claims to correct various provider updates.
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? Communicate with members, providers, and other insurance carriers via telephone.
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? Perform basic and complex adjustments on previously processed claims using various tools and systems.
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? Review files and analyze results to organize multiple adjustments and accumulator updates as needed.
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? Monitor logs with manually tracked offsets for ASO prepay claims.
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? Assist with gathering data for group audits.

Requirements
? High school diploma or equivalent.
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? One or more years of experience working with insurance claims.
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? Strong reading, writing, and verbal communication skills.
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? Ability to handle complex support functions accurately and timely.
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? Ability to work well under pressure with frequent interruptions and shifting priorities.
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? Analytical, problem-solving, organizational, and detail orientation skills.

Nice-to-haves
? Experience with Delta Dental contractual and administrative policies affecting claims.
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? Familiarity with Facets claims and CS tasks.

Benefits
? Medical, Dental, Vision, Pharmacy, Life, & Disability insurance
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? 401K with matching
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? Flexible Spending Account (FSA)
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? Employee Assistance Program
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? Paid Time Off (PTO) and Company Paid Holidays

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