MANITOBA BLUE CROSS - POSITION DETAIL

Dental Claims Representative - F/T Term Position (230813)

Job Number: (230813)
Department: Claims
Location: Winnipeg
Job Type: Temporary
Close Date: 08/30/2013
Professional Areas: Claims
Salary Range: Competitive Wages & Modified Benefits Program
Description:

JOB TITLE

DENTAL CLAIMS REPRESENTATIVE
F/T Term Position (230813)

REPORTS TO

Supervisor, Dental Claims


POSITION SUMMARY:

The Dental Claims Representative assesses, adjudicates and processes diverse dental claims, coordination of benefits and pre-calculated claims, responds to written and telephone inquiries from subscribers/providers, and updates and maintains various production reports.

DUTIES AND RESPONSIBILITIES:

  • Assesses, adjudicates and processes dental claims for payment by on-line entry in accordance with performance standards.
     
  • Assesses and pre-calculates claims with non-standard procedures, if required.
     
  • Corrects weekly Edit Error Reports and re-submits corrected claims on an assigned basis.
     
  • Processes pre-authorization claims by on-line entry or manual on an assigned basis.
     
  • Reviews large amount or questionable pre-authorizations with Dental Consultant and keeps written record of pre-authorization status when required.
     
  • Processes manual payments, and enters “Stats” by on-line entry.
     
  • Processes subscriber address changes when required.
     
  • Processes coordination of benefit claims by on-line entry on assigned basis.
     
  • Issues Bonds as requested.
     
  • Replaces stale-dated cheques as required and enters the appropriate “Stats”.
     
  • Draws back stale-dated cheques as requested by Accounting Department.
     
  • Responds to written and telephone inquiries from subscribers and dentists.  Completes necessary adjustments.
     
  • Maintains daily production records and submits these to Supervisor each Friday.
     
  • Edits on-line CDAnet claims and pre-authorizations.
     
  • Performs other related duties as assigned.
     

SKILLS AND QUALIFICATIONS:

  • Dedicated to the principles of exceptional service; committed to responding to, anticipating, and addressing customer needs, for both internal and external customers.  
     
  • Community College diploma and 1-2 years of dental office experience including experience with dental coding, terminology and products.  Equivalent combination of education and experience may be considered.
     
  • Excellent interpersonal skills with the ability to communicate effectively with subscribers and providers in a professional manner.
     
  • Proficiency in Microsoft Office programs and the ability to learn and use a variety of mainframe applications relevant to the Dental Claims department.
     
  • Strong mathematical and analytical skills.
     
  • Data entry experience.
     
  • Well organized and capable of handling multiple tasks.
     
  • Previous claims adjudication experience an asset.
     
  • Completion of, or in the process of completing insurance industry courses such as LOMA 1 and 2 considered an asset.

Manitoba Blue Cross offers a competitive wage and modified benefits program. Qualified applicants should submit a cover letter and resume, indicating wage expectations, by August 30, 2013.
 

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