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Claims Manager

Description

Delta Dental of Colorado is a nonprofit company with a mission to improve the oral health of the communities we serve-something we take very seriously. We could not do that without the hard work and dedication of our team members.

When you work for Delta Dental, you will gain valuable experience with a progressive organization known as the first company to specialize in dental benefits. Delta Dental allows team members to work with confidence in a culture defined by resilience and optimism, where the fervor to learn and perform is rewarded.

Join our team and take advantage of a brand-new modern office with onsite health and fitness centers, competitive pay, a top-of-the-line benefits program and opportunities for professional growth and development.

Essential Duties:

  1. Aware of, and is knowledgeable about, state, and federal laws impacting all functions performed in the department and takes all necessary action to ensure compliance with these requirements. Familiar with standards set out in the Corporate Code of Conduct and Business Ethics Policy and acts to always uphold these requirements.
  2. Motivates staff and promotes teamwork for all direct reports, thus ensuring the existence of a cohesive work environment. Monitors and maintains performance metrics including quality auditing. The manager performs coaching, mentoring, interviewing, hiring, and recommendation for terminations if/as necessary.
  3. Responsible for overseeing the training and cross-training of Maintenance of current and accurate documentation of policies and procedures for claims adjudication. Work closely with Learning and Development to update materials and create new training opportunities.
  4. Interfaces with the Manager Clinical Review regarding claim inventory management.
  5. Responds to claim questions to provide needed Coaches, as necessary.
  6. Facilitates the handling of all escalated claim inquiries and/or assists with escalated call inquiries as necessary to resolve caller issues.
  7. Facilitates all external claim audits, inclusive of gathering all requested audit files.
  8. Writes and conducts staff performance reviews according to the timeline established by Human Resources.
  9. Proactively works to enhance operational performance and efficiencies.
  10. Meets or exceeds all DDPA and performance guarantee metrics.
  11. Acts as backup and support to co-managers within the department during periods of absence.
  12. Facilitates claim queries and reports including full resolution of claims issues, as necessary. Resolution may include interaction with other departments and/or mass claims adjustments.

Competencies:

  • Solid computer skills.
  • Solid knowledge of dental insurance industry terminology and services.
  • Solid problem solving and conflict resolution skills.
  • Ability to exercise initiative and judgment as well as make decisions within the scope of authority.
  • Solid written and verbal communication skills with the ability to effectively communicate and interact with all levels of personnel and the public.

Qualifications:

  • Minimum of three (3) years prior supervisory experience preferred.
  • Associates degree required; BS/BA preferred.
  • Experience in process improvement strategy and critical thinking.
  • Knowledge of dental insurance industry regulations, statutes, and procedures.
  • Understand the dental claims process, importance of applying accurate and consistent processing procedures, attention to detail, and acknowledge the affect these processes have on all aspects of operations within Delta Dental of Colorado.

Equipment Utilized:

  • Requires use of standard office equipment, and equipment requiring simple set up and adjustments to include word processing equipment.

Scope of Authority:

  • Some precedents and/or procedures exist. Expected to handle different and specialized situations in department and assigned areas. Utilizes, but is not limited to the following reference tools: Processing Guidelines, Dentist Handbook, Delta Dental of Colorado Employee Guidelines, Management Policies, and department handbook are utilized as reference tools. Prepares and/or develops plans for projects and programs involving coordination with other departments and/or outside organizations. Plans own work and the work of others to meet defined work plans and objectives. Work is not reviewed.
  • Financial Authority:
    • Authority to approve payments to providers and/or members on a claim-by-claim basis.
    • Responsible for providing input in the budgeting process for Claim Operations.
    • Has impact on Groups, Members and Providers.

Work Conditions:

  • No physical effort beyond that typically required in a normal office environment. Light physical effort is generally required handling objects up to 20 pounds occasionally and/or up to 10 pounds frequently. Regular and reliable attendance is required. The noise level in the work environment is usually minimal. Primarily sedentary work with regular exposure to a computer screen.

Delta Dental of Colorado offers a comprehensive compensation and benefits package. Some of the highlights from our benefits package include:

  • Generous PTO
  • 9 paid holidays
  • Two affordable health plans
  • Fantastic dental insurance plan
  • 401(k) match with immediate vesting
  • Supplemental retirement savings plan
  • Company-paid life insurance, short-term disability, and long-term disability policies
  • Wellness program
  • Tuition reimbursement
  • Transportation reimbursement (we are near a light rail station!)
  • Annual bonus program
  • Paid volunteer time off

Delta Dental of Colorado is proud to be an Equal Opportunity and Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity, genetic information, military or veteran status, national origin, race, religion, sex, sexual orientation, or any other applicable status protected by state or local law.





Posted
07/15/2022
Salary Range
$60,000.00 - $78,000.00
per Year
Salary range estimated by
salary estimation provided by zippia
Location
Centennial, CO, 80111, US