Medical / Dental Claims Specialist $60,000+

Medical / Dental Claims Specialist 

Comma Recruitment are looking for a medical and dental claims specialist with 3+ years adjudication experience, responsible for handling large and complex Health and Dental claims and providing the tools necessary for them to identify any potential fraudulent claims. You will also develop and maintain the department processes and administrative practice documents. When the need arises, you’ll eagerly back up and be a resource for Team Leaders.

You will be responsible for auditing and overseeing scheduled and random audits of claims examiners and electronically submitted claims. It will be your responsibility to set up new medical/dental plans and amendments.

On a day to day basis you will conduct internal claim audits to ensure a high standard of adjudication. You will maintain an audit file for each examiner, and submit a written report of findings to the Manager on a weekly basis. Quarterly, you will organize and chair one department meeting to report on all recent fraud issues, initiatives and system process improvements or changes.

In this role, you will provide the Claim Manager with all supporting documentation and reports relating to, but not limited to, fraudulent claims, audited claims and key performance measures.

Success in this role would be the mastery of the processes you touch on a day-to-day basis and your ability to keep abreast of industry and government requirements.  Success could lead to taking on a supervisory role.

This role requires:

• Resilience – you know how to juggle deadlines and competing demands. When you’re under pressure, you rise to the occasion.
• Team mindset – you look for ways to pitch in, and work well with a variety of personalities.
• A positive attitude – our team is a positive, supportive group. When work is challenging, you’ll face it with optimism.
• You present yourself professionally in your writing, speaking and appearance.

Qualifications

• 3 – 5 years adjudicating Health and Dental Claims, experience with auditing claims would be an asset.
• Superior communication and customer service skills
• Requires above average report preparation skills, using current computer related tools (Excel, Power Point)
• Requires the ability to present well in client meetings and to lead department meetings
• Excellent analytical and letter writing skills, with attention to detail and accuracy
• Ability to prioritize, multi-task and adapt well to change in a busy office environment
• Ability to work well under pressure, meet deadlines and adhere to departmental standards
• As a self-directed individual, you demonstrate good judgment with the ability to initiate and accomplish tasks expediently and with minimum supervision

Please forward resume to [email protected]