Dental Claims Approver II
About the position The Group Dental Claims Approver position at Guardian is an entry-level role designed for individuals who are driven and service-oriented. This position requires a strong attention to detail to efficiently process dental claims that cannot be automatically handled by the mainframe system. As a Dental Claims Approver, you will be responsible for reviewing and processing claims, applying state laws, and referring claims to consulting dentists to determine the necessity of treatment. You will also investigate and respond to written appeals, inquiries, and complaints, ensuring that all claims are followed up on and that any additional information needed is obtained. This role is not customer service-oriented, meaning no phone work is required, allowing you to focus on the claims processing tasks at hand. Guardian emphasizes the importance of a strong onboarding and progressive training program, which will expose you to the workings of insurance policies, business writing, and claims processing. The foundational skills you will acquire will ensure a high level of accuracy in claims processing and serve as a stepping stone for further development within the company. The work environment is fast-paced and production-focused, requiring individuals who can deliver high-quality results while working independently. You will be expected to maintain good attendance and be willing to work overtime during peak seasons to meet service requirements. The department operates from 6:00 AM PST to 6:00 PM PST, with a 40-hour work week and productivity and quality goals to achieve.
Responsibilities
- Process data entered, scanned, electronically submitted, and dental claims that cannot be pended.
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- Apply state laws to the processing of initial claims and appeals.
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- Refer claims to consulting dentists to determine necessity of treatment.
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- Investigate and respond to written appeals, inquiries, and complaints.
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- Follow up on claims that need additional information or are pending in the system.
Requirements
- Strong time management skills.
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- Ability to succeed in a fast-paced, production-focused environment.
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- Deliver high-quality results while working independently.
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- Demonstrate self-awareness and embrace feedback.
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- Eager to continuously learn and retain new knowledge and skills.
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- Ability to follow standard operating procedures and navigate multiple computer applications.
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- Demonstrate analytical, organizational, problem-solving, and relationship-building skills.
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- Strong oral and written communication skills.
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- Proficient PC skills including mainframe systems.
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- Demonstrate honest and ethical behavior.
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- Maintain a high sense of priorities and use solid judgment to make routine decisions.
Nice-to-haves
- Experience in claims processing or insurance is a plus.
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- Familiarity with dental terminology and procedures.
Benefits
- Choice of high deductible/copay medical plans with prescription drugs, including coverage for fertility and transgender inclusive benefits.
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- Dental plan and vision plan.
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- Health care accounts - flexible spending, health reimbursement, and health savings accounts.
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- Company-paid life and disability insurance plus voluntary supplemental coverage.
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- 401(k) retirement plan with a company match, plus an annual age/service-based company contribution and an annual profit-sharing contribution, if applicable.
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- Flexible work arrangements (part in-person/part remote).
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- Unlimited paid time off for most roles plus time off for volunteering, jury duty, voting, and bereavement.
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- Paid parental leave and paid family and medical leave policies.
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- Emotional well-being, mental health, and work/life resources powered by Spring Health.
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- Wellness programs, including fitness program and equipment reimbursement.
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- Adoption assistance and tuition reimbursement.
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- Commuter benefits in select metropolitan areas.
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