Dental and Medical Health Insurance Claims Examiner
Job Title: Dental & Health Claims Examiner – India Location: Remote (India) Job Type: Full-Time Department: Claims Processing Reports To: Claims Manager Company: U.S.-Based Dental Insurance Provider Position Summary We are hiring experienced and detail-oriented Claims Examiners based in India to support the operations of a U.S.-based health insurance provider. This role involves reviewing and adjudicating dental and health insurance claims accurately and efficiently, in line with U.S. benefit plans and regulatory requirements. Candidates with knowledge of CDT, CPT, and ICD-10 codes and prior experience processing U.S. claims are strongly preferred.
Key Responsibilities
- Process and adjudicate dental and health insurance claims according to U.S. plan guidelines.
- Verify member eligibility, provider details, and benefit coverage.
- Interpret and apply CDT, CPT, and ICD-10 codes with high accuracy.
- Identify claim discrepancies, errors, and potential fraud; escalate when needed.
- Communicate clearly and professionally with internal teams and provider networks.
- Meet daily and weekly performance metrics for claim volume and accuracy.
- Stay updated on changes to U.S. health and dental coding and compliance standards.
Required Qualifications
- Minimum 2 years of experience in dental or health claims processing for U.S.-based insurers.
- Proficient in claims systems and workflows, including EDI and adjudication tools.
- Sound knowledge of CDT, CPT, and ICD-10 coding.
- Excellent written and verbal communication skills in English.
- Strong analytical, organizational, and attention-to-detail skills.
- Ability to work independently and maintain strict confidentiality.
- Familiarity with HIPAA and U.S. insurance industry standards.
Preferred Qualifications
- Prior BPO/KPO or third-party processing experience in U.S. claims.
- Certified in medical or dental coding (CPC, CPD, or equivalent).
- Experience in coordination of benefits (COB), pre-authorization, and provider network validation.
Work Schedule
- Must be available to work U.S. business hours (5:30 PM to 2:30 AM IST, or similar shifts depending on U.S. timezone alignment).
- Monday to Friday (occasional weekend work if business requires).
What We Offer
- Competitive salary and performance-based incentives.
- Remote work flexibility with required infrastructure support.
- Training, career development, and opportunities for advancement.
- Collaborative and fast-growing international work environment.
Job Type: Full-time Work Location: Remote Apply Job! Apply to this Job