[Hiring] Dental Appeals Senior Claims Examiner @Lincoln Financial

Role Description

This position is responsible for the review of denied Dental Claims. You will manage dental claims appeals by providing an independent review of the facts and circumstances, within the state and federal regulations including ERISA/DOL. In this role, you will act on new dental claim appeals within 5 business days, and render appeal decisions within 15 days for pre-service, and 30 days for post-service. Written communication of appeal upholds will be clear and concise, citing policy and decision rationale in clear, easy to understand terms. You will partner with other departments, such as Enrollments and DentalConnect as needed, while adhering to PHI.

What you'll be doing:

• Analyze & process claims by investigating information.
• Apply claim policies & procedures and engage intervention of internal/external resources to ensure fair, ethical, & timely management of assigned claims.
• Analyze and interpret complex coverage contracts to determine if eligibility is met.
• Liaise with various stakeholders from across the business (Enrollments, DentalConnect) to obtain needed information to clarify and address issues.
• Provide customers with explanations of policy details and claim determination.
• Effectively utilize and implement policies & procedures regarding overall claims workflow.
• Propose and develop practices & processes to improve performance and the customer experience.
• Work as an individual and part of a team to ensure all new appeal assignments are acted on within department turnaround times.

Qualifications

• High School diploma or GED or minimum Associate degree in lieu of required experience. (Minimum Required)
• 3 - 5+ Years of DENTAL CLAIMS processing experience directly aligned to the specific responsibilities for this role. (Required)
• 3-5 years experience processing dental claims. (Nice to have)
• Understand dental medical terms, records and test results. (Nice to have)
• Ability to read, analyze and interpret Dental policies. (Nice to have)
• Demonstrate strong written and verbal communication. (Nice to have)
• Ability to work with others in a team environment. (Nice to have)
• Demonstrates excellent organizational skills with the ability to prioritize workload and multi-task while maintaining strict attention to detail. (Nice to have)
• Demonstrates strong interpersonal skills with a collaborative style. (Nice to have)
• Demonstrates the ability to use sound judgment and discretion regarding confidential information. (Nice to have)

Benefits

• Clearly defined career tracks and job levels, along with associated behaviors for each of Lincoln's core values and leadership attributes.
• Leadership development and virtual training opportunities.
• PTO/parental leave.
• Competitive 401K and employee benefits.
• Free financial counseling, health coaching and employee assistance program.
• Tuition assistance program.
• Work arrangements that work for you.
• Effective productivity/technology tools and training.

Company Description

Lincoln Financial (NYSE: LNC) helps people to confidently plan for their version of a successful future. We focus on identifying a clear path to financial security, with products including annuities, life insurance, group protection, and retirement plan services.

With our 120-year track record of expertise and integrity, millions of customers trust our solutions and service to help put their goals in reach.