TL-Claims HC

Job Summary

Join our team as a Claims Specialist focusing on TL-Claims HC where you will utilize your expertise in Facets - Claims and Claims Adjudication. With 5 to 8 years of experience you will manage Dental and Commercial Claims ensuring accuracy and efficiency. This role requires working from the office during night shifts with no travel required. English proficiency is essential.

Responsibilities

• Manage and adjudicate claims using Facets
• Claims system ensuring accuracy and compliance with company standards.
• Analyze and process Dental and Commercial Claims identifying discrepancies and resolving issues promptly.
• Collaborate with team members to streamline claims processing and improve operational efficiency.
• Provide expert guidance on claims adjudication processes ensuring adherence to industry regulations.
• Monitor claims workflow and implement strategies to reduce processing time and enhance productivity.
• Conduct regular audits of claims to ensure compliance with internal and external policies.
• Develop and maintain documentation related to claims processes ensuring clarity and accessibility for team members.
• Communicate effectively with stakeholders to address claims-related inquiries and provide timely resolutions.
• Utilize advanced analytical skills to identify trends and propose solutions for claims management improvements.
• Train and mentor junior team members on claims processing techniques and best practices.
• Coordinate with cross-functional teams to ensure seamless integration of claims processes within broader business operations.
• Implement quality control measures to ensure high standards of claims processing are maintained.
• Report on claims processing metrics and provide insights to management for strategic decision-making.
  
  

• Possess strong expertise in Facets
• Claims and Claims Adjudication with proven experience in managing complex claims.
• Demonstrate proficiency in handling Dental Claims and Commercial Claims with a focus on accuracy and efficiency.
• Exhibit excellent communication skills in English both written and spoken to effectively interact with stakeholders.
• Show ability to work independently and collaboratively in a fast-paced office environment during night shifts.
• Display strong analytical skills to identify trends and propose actionable solutions for claims management.
• Have experience in training and mentoring team members to enhance their claims processing skills.
• Maintain a detail-oriented approach to ensure compliance with industry regulations and company policies.