出海雷达

理赔审核员（US）

Claims Examiner (US)

其他限定地区（需当地身份）
公司firstsourc
薪资未公开
工作地点United States
地域资格限定地区（需当地身份）
时区要求日间重叠约 9 小时，基本正常作息
用工类型Full Time
发布时间3 天前
数据来源Himalayas
前往 Himalayas 查看并投递 →
注意地域限制：该职位明确限定在 United States 招聘。如果你是位于中国大陆的求职者，通常需要当地工作身份才能投递，或需与雇主确认是否接受独立合同（Contractor）形式合作。

Claim Processor/Adjustor

Reviewed 9.2025

Delta Dental of Illinois

职位描述

职位名称：Claim Processor/Adjustor

部门：理赔

汇报对象：理赔经理

薪资状态：非豁免员工

职位概述：Claim Processor/Adjustor 负责通过准确处理牙科理赔以及解决各种类型的牙科理赔相关咨询，为 DDIL 客户提供服务。

职责与义务：

 根据已建立的业务规则调查并处理未能通过计算机程序编辑的理赔

 在需要高级技术及牙科知识的理赔处理中提供指导

 达到 ITL 设定的每日/每周理赔生产目标

 完成并维护每日审计生产日志

 在规定的时间范围内准确完成分配的特殊项目

 按照公司和部门层面制定的现行指南访问 EPHI

 保持定期和准时出勤

 执行其他分配的工作相关职责（专业审核、申诉审核、电子表单）

 按照 ITL 或经理设定的时间框架，更新 ITL 或经理关于所分配报告的日常状态

 鼓励根据业务需求加班

 按照公司和部门层面制定的现行指南访问 EPHI

 保持定期出勤和准时性

 执行其他分配的工作相关职责

经验与资格：

 优秀的口头和书面沟通能力。出色的电脑键盘操作技能。了解保险报销实践，即理赔处理政策、免赔额、最高限额、利益协调（COB）和牙科术语

 能够独立工作并同时执行多项任务

 优秀的出勤和准时记录

Claim Processor/Adjustor

Reviewed 9.2025

虽然不是该职位的必要条件，但优先考虑以下人员：

 能流利使用西班牙语，或

 能根据提供者的理赔叙述、牙科照片和 X 光片进行诊断判断

员工签名 日期

最初发布于 Himalayas

查看英文原文

Claim Processor/Adjustor

Reviewed 9.2025

Delta Dental of Illinois

Job Description

JOB TITLE: Claim Processor/Adjustor

DEPARTMENT: Claims

REPORTS TO: Manager, Claims

PAY STATUS: Non-Exempt

OVERVIEW OF POSITION: The Claim Processor/Adjustor is responsible for providing service to the DDIL client

base through accurate processing of dental claims as well as troubleshooting and resolving all types of dental

claim related inquiries.

DUTIES & RESPONSIBILITIES:

 Investigate and process claims according to established business rules that have failed computer program

edits

 Provide guidance in claims processing requiring advanced technical and dental knowledge

 Meet daily/weekly claim production goals as set by the ITL

 Complete and maintain daily audit production logs

 Accurately completes special projects assigned within specified time frame

 Access EPHI following the current guidelines as established at the company-wide and department levels.

 Maintain regular and punctual attendance

 Perform other job-related duties as assigned (Professional Review, Appeals Review, E-Forms)

 Update ITL or Manager regarding daily status of assigned reports by timeframe established by ITL or

Manager.

 Encouraged to work overtime according to business need.

 Accesses EPHI following the current guidelines as established at the company- wide and department levels.

 Maintains regular attendance and punctuality.

 Performs other job-related duties as assigned.

EXPERIENCE & QUALIFICATIONS:

 Excellent oral and written communications skills. Strong computer keyboard skills. Knowledge of insurance

reimbursement practices, i.e. processing policies, deductibles, maximums, Coordination of Benefits (COB)

and dental terminology.

 Ability to work independently and execute multiple tasks simultaneously

 Excellent attendance and punctuality record.

Claim Processor/Adjustor

Reviewed 9.2025

While not a requirement for the position, a preference is given to those who:

 can speak Spanish fluently, or

 can make diagnostic determinations based on provider claim narratives, dental photos and radiographs

Employee Signature Date

Originally posted on Himalayas

本页面信息整理自 Himalayas，版权归原发布方所有。职位可能随时关闭，投递请以原始页面为准。 本站只做信息聚合展示，不参与招聘流程，也不向求职者收取任何费用。

该公司其他在招职位

远程团队领导

firstsourcUnited StatesFull Time6 天前
市场运营职能支持限定地区（需当地身份）

← 返回全部职位