Salary
💰 CA$54,000 - CA$91,000 per year
About the role
- Carrying out the claims examination process of dental claims with higher complexity and providing expert analysis of complicated or unusual claims
- Ensure accurate and timely processing of complex claims and estimates for reimbursement to members
- Assess dental x-rays and claims, review complex claims for completeness and follow processes for incomplete information on claims
- Assess and adjudicate complex claims and estimates, including studying dental information and plan provisions, researching, documenting results
- Communicate verbally and/or in writing with the client (member/sponsor) to obtain additional details to make informed decisions
- Produce internal and external correspondence and handle external and internal inquiries via written correspondence, e-mails and telephone
- Meet production and quality standards set for individuals, teams and department (timeliness, quality and service)
- Participate in departmental projects as required and work with Dental Consultant on contentious cases
- Collaborate with other departments/offices within the company to meet customer expectations
Requirements
- Diploma in Dental Hygiene (CEGEP/College or University)
- Experience working in a dental clinic
- Strong knowledge of Group Insurance - Dental claims
- Customer service oriented
- Excellent communication skills both verbal and written
- Excellent problem solving skills
- Self motivated
- Team oriented
- Ability to work in a changing environment
- Strong decision making skills
- Open to receiving and giving feedback