Claims Auditor

This is a remote position. Delta Dental of Michigan, Ohio, and Indiana is a leader in dental benefits, plus so much more. We improve oral health through benefit plans, advocacy and community support, and our corporate giving builds healthy, smart, vibrant communities for all. We devote our time, talents and financial resources to improve oral and overall health, and we invest in initiatives that support youth, education, workforce and economic development. We are a force for good--part of the reason why employees find working at Delta Dental fulfilling. Delta Dental companies nationwide comprise the Delta Dental Plans Association, which provides coverage to more than 83 million Americans and operates two of the nation's largest networks of participating dentists. For more, visit www.deltadentalmi.com and www.vibrantcommunities.com, and apply online at www.deltadentalmi.com/careers. Typical Assignments: Analyzes, adjudicates, and processes dental claims so that non-clinical determinations can be finalized using policies, procedures, and bypasses. Reviews member's group coverage to determine type and level of benefits Uses system and other sources to obtain information needed to process claim determinations, including DeltaUSA processing policies, group contracts, provider agreements, and federal and state laws applicable to claims adjudication Determines payment amounts when appropriate Reviews, modifies, and corrects claims in the system as needed, including claims that are not billable to patient Sends requests to dental offices seeking additional claims information, using proper grammar and punctuation Calculates basic mathematical functions Operates office equipment which may include a personal computer, calculator, copier, fax machine, etc. Maintains claim records and related departmental records and files