Delta Dental of Arizona, the state’s #1 dental insurance company, is looking for a proactive Claims Processor I that has excellent communication skills and enjoys being part of a team. The ideal candidate has one year of dental office or customer service experience and advanced knowledge of CDT coding and dental terminology.

About You

You are the person that is called when someone is looking for something they can’t find. And you’ll find it quickly. You enjoy multitasking. Mysteries are your jam, and you usually figure out the ending before others. You enjoy connecting the dots and coming to the correct solution.

You enjoy something different every day, and your problem-solving talents make you the go-to person in a pinch. You realize how you get there is just as important as getting there when it comes to your team. It’s just more fun to win as a team.

Sound like you? Please read on!

This position is able to be a fully remote position with the starting pay range to be between $15 - $18.22 per hour as a full-time position.

Essential Functions

• Determine and compute benefits allowable and/or payable according to the terms of provider contracts, plan documents, certificates/evidence of coverage, and policies and procedures, ensuring all expenses meet established criteria and adhere to state and federal regulation/requirements
• Review history for potential pre-existing conditions as required by group contract, request and forward dental records/X-Rays, and make appropriate benefit determinations
• Utilization of benefits structures to apply claim processing logic to adjudicate and process/adjust claims accordingly.
• Determine and compute eligible benefits for claims subject to COB adhering to NAIC, ERISA, and state and federal guidelines; review prior claim history for duplicate payments and accuracy
• Initiate process to recover funds from overpayments or to issue add pays for underpayments
• Achieve and maintain required claims turnaround time from receipt to online entry in accordance with contractual and regulatory requirements
• Provide data entry functions which includes daily required quotas
• Achieve and maintain consistency in meeting quality and quantity standards
• Communicate and interface with members/participants, employers, and providers to clarify contractual agreements, provider billing issues, dental necessity, service rendered, utilization review, pre-determination criteria, eligibility, and policy language
• Support the call center as key contact and representative of Delta Dental Plan of Arizona
• Provide coverage, as necessary, for call center phone queues in support of meeting established performance guarantees
• Maintain proper communication with all members, dependents, dentists, dental staff, and other callers
• Provide accurate responses to telephone inquiries in a professional manner.
• Completes special projects as assigned by management
• Other duties as assigned

• 
  Advanced knowledge of CDT coding and dental terminology
• Able to evaluate and interpret dental records
• Able to interpret insurance plan documents
• Basic math skills
• Knowledgeable of HIPAA regulations
• Intermediate MS Office Skills
• Knowledgeable of state and federal insurance regulations

Minimum Qualifications

• High School diploma or equivalent is required
• Minimum 1 year of dental office experience and/or customer service; claims experience preferred
• Excellent communication skills
• Exceptional time management skills required
• Ability to maintain strict confidentiality in accordance with DDAZ policies and HIPAA regulations

About Us

Delta Dental of Arizona’s vision is simple; healthier lives for everyone. That’s why we’ve made it our mission to create a path to better health and wellness. We’re a dental and vision healthcare provider with a foundation that has awarded millions in grants to organizations who care for our most vulnerable residents by offering the dignity and hope that a healthy smile brings.

Our employees enjoy competitive compensation and comprehensive benefits, including medical, dental, vision, 401(k), student loan assistance, volunteer PTO, and a culture that embraces collaboration, service, integrity, and inclusion. At less than 135 employees, we cultivate a work community where all employees are known by name, and everyone’s contributions are visible, noticed, and celebrated. We provide flexible schedules and hybrid work options when possible. Our employees have a lot to smile about!