Dental Claims Support

Moda Health
Portland, OR
30+ days ago
Moda Health
Moda Health

Job Description

Let’s do great things, together.

Founded in Oregon in 1955, ODS, now Moda, is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Moda Health is seeking several people to fill our open Dental Claims Support roles. The Dental Claims Support role provides backup to support leads including training of staff. Investigates complex file reviews and processes complex claims adjustments and Coordination of Benefits (COB) claims, including phone calls, overpayment recoveries, stop pays, and void checks. Responsible for sorting, assigning and working various reports such as building member accumulators, giving deductible credits, adjusting claims to correct various provider updates.

Primary Functions:

1. Understands and follows compliance rules to process claims including requesting refunds, and issuing additional benefits, for Medicare, Oregon Health Plan, commercial group and individual plans.

2. Documents thoroughly as required by internal procedure and market conduct guidelines in a clear and concise manner and analyzes and interprets existing file notes and documentation.

3. Excellent knowledge and understanding of Delta Dental contractual and administrative policies affecting claims. Able to interpret requests from members, providers, and other internal departments to ensure the request is within contractual and administrative guidelines.

4. Communicates by telephone with members, providers, and other insurance carriers.

5. Sends custody, primary payment, refund request, and other form letters in timely manner.

6. Performs basic and complex adjustments on previously processed claims using Facets claims and CS tasks, Content Manager workbaskets, NEA Fast-Attach, emails and reports.

7. Investigates and processes COB claims in a timely manner and updates information as required.

8. Reviews User Procedure Manuals (UPMs) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.

9. Identify and refer trends in the system and procedures and recommend improvements to increase efficiency and reduce errors.

10. Performs detailed claims files review to determine over/underpayments and provides back up to claims processing and training units when needed.

11. Responds to and follows up with Customer Service tasks/issues.

12. Monitor logs with manually tracked offsets for ASO prepay claims.

13. Assist with gathering data as requested for group audits.

14. Ability to perform a high level review of clinical chart notes for relevancy.

15. Performs other duties as assigned, including department reports and projects.

Are you ready to be a betterist?

If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

1. Associate’s degree, or equivalent work experience. 2. Strong reading, writing and verbal communication skills. 3. Ability to handle the most complex support functions accurately and timely. 4. Ability to back up on all Claim Support functions as well as accept additional responsibilities while still maintaining current work load. 5. Ability to work well under pressure with frequent interruptions and shifting priorities 6. Analytical, problem solving, organizational, and detail orientation skills. 7. Accurately track money received (refunds) and post to correct member, provider & group accounts. 8. Reviews Files and analyzes results and organizes multiple adjustments and/or accumulator updates as needed. 9. Accurately track and request appropriate funds to be reissued to members & providers. 10. Ability to maintain balanced performance, which meets expectations in areas of production and quality. 11. Meet or exceed company attendance standards.


Not sure if you qualify?

Uvaro is here to help you land great jobs like this one.

Upgrade your skills

Other Jobs

Rise People

Rise is Canada’s complete people management solution that gives employers everything they need to build loyal and productive teams—all in one place. We collaborate and co-create to build solutions that completely change how companies of all shapes and sizes manage their payroll, scheduling, time tracking, group benefits, recruitment, onboarding, and more.

Vancouver, BC

1+ years of successful sales development experienced experience in B2B software or B2C services is a plus. Ability to work occasional evenings or weekends.

Waterloo, ON / Remote
Freshworks Inc

About Freshworks: Freshworks makes it fast and easy for businesses to delight their customers and employees. We do this by taking a fresh approach to building and delivering software that is affordable, quick to implement, and designed for the end-user. More than 50,000 companies -- from startups to public companies -- around the world use Freshworks software-as-a-service to enable a better customer experience (CRM) and employee experience (ITSM, HRSM). Headquartered in San Mateo, California, Freshworks has a dedicated team operating from 13 global locations to serve customers, including American Express, Sony, Vice Media, TaylorMade, Sotheby’s, Stitchfix, OfficeMax, Multichoice, Delivery Hero, ITV, and Klarna. Freshworks transforms the way world-class organizations collaborate with customers and co-workers. The suite includes Freshdesk (omnichannel customer support), Freshsales (sales automation), Freshmarketer (marketing automation), Freshservice (IT service desk), Freshteam (HR management system). Overview: We are looking to hire smart and passionate folks for our inside sales team. The inside sales team are responsible for engaging with prospects and driving sales in the SMB segment. They understand the needs and requirements and collaborate with internal teams to help ensure a smooth sales process. This role is based out of Chennai. Responsibilities (What you'll be expected to do): - Qualify and prospect inbound leads generated by the lead generation team. - Be responsible to convert trial prospects to paid customers through enthusiastic customer engagement. - Own individual targets and work towards generating new revenue. - Collaborate with other appropriate internal teams and represent the customers to solve their business requirements. - Work with various internal stakeholders and achieve team targets. Requirements (What we look for in candidates): Must-haves: - 1-3 years of work experience in any customer-facing sales role. - Clear, concise, and effective written and oral communication skills. - Empathy towards customers and understanding their needs. - Interest, curiosity, and openness to learning new technologies. - Good interpersonal skills and ability to collaborate with internal stakeholders as well as end customers. - Learning mindset and the right attitude that will help you thrive and adapt in a fast-paced, performance-driven environment. - Flexibility in working in different shifts/regions. This is absolutely mandatory because you will be expected to work in a specific shift for a minimum of two years. Good to have: - Prior work experience in SaaS product companies in domains relevant to Freshworks' suite of products. - The proven track record of consistency in overachieving targets.

5 hours ago
Tamil Nadu Chennai