A Dental Claims Processor assesses insurance claims for patients who visit the dentist’s office. The job duties include ensuring each claim is complete and the treatment received meets the criteria for the coverage as set by the insurance company. Other core duties are mentioned on the Dental Claims Processor Resume as – analyzing if the claim will be paid or not by the insurance company, reviewing the insurance policy, thoroughly determining the kind of coverage, providing necessary guidance to claimants on how to file a claim, preparing claim forms and other paperwork, escalating complicated or unusual claims to claims investigators, and performing other administrative tasks.
Those in this field often embrace the following skills and abilities – detail-oriented to understand complex paperwork, strong customer service skills, people skills, the ability to deal with frustrated and angry customers; strong logic and reasoning skills to solve a variety of coverage-related issues, and multitasking skills. While an extensive education is not a must, possessing a high school diploma is a basic requirement.
Objective : Dedicated professional with two years of experience in dental claims processing, adept at verifying claims, ensuring compliance with regulations, and liaising with insurance providers. Proven ability to streamline processes and enhance accuracy in claims submission. Committed to delivering exceptional service and supporting patient needs through efficient claims management.
Collaborated with the Dental Supervisor to refine claims processing protocols.
Acquired knowledge of dental coding and insurance services.
Trained in various dental procedures to enhance claim accuracy.
Managed online training sessions and daily quality checks.
Maintained high production levels while ensuring accuracy in claims.
Resolved audit discrepancies through detailed analysis and rebuttals.
Addressed personal commitments while managing professional responsibilities.
Experience
0-2 Years
Level
Entry Level
Education
AAS HIT
Junior Dental Claims Processor Resume
Objective : Results-oriented professional with 5 years of experience in dental claims processing, skilled in verifying and adjudicating claims while ensuring compliance with industry regulations. Proficient in collaborating with insurance providers to enhance claim accuracy and efficiency. Passionate about delivering exceptional service to patients and streamlining claims operations for optimal outcomes.
Skills : Research Skills, Team Collaboration, Analytical Skills, Conflict Resolution, Multi-tasking
Description :
Communicated effectively with insurance agents and beneficiaries to resolve claims-related inquiries.
Review and process dental claims for accuracy and compliance with policies.
Reviewed and verified claim submissions, maintaining compliance with industry regulations.
Verify patient eligibility and benefits for dental services.
Assessed policy coverage and calculated claim amounts for accurate processing.
Processed claim payments promptly and accurately, ensuring financial accountability.
Adhered to federal, state, and company regulations in all claims processing activities.
Experience
2-5 Years
Level
Junior
Education
AAS in HIT
Dental Claims Processor Resume
Headline : Results-driven Dental Claims Processor with 7 years of expertise in verifying, adjudicating, and managing dental claims in compliance with industry standards. Adept at optimizing processes to enhance accuracy and efficiency while maintaining exceptional service to patients and providers. Committed to continuous improvement and fostering strong relationships with insurance partners.
Skills : Report Generation, Insurance Policies Knowledge, Claim Submission, Fraud Detection, Process Improvement, Training And Mentoring
Description :
Processed an average of 183 claims daily with a 99% quality rating.
Analyze claim data to identify trends and issues.
Reviewed x-rays for major services to facilitate accurate assessments by consultants.
Maintained comprehensive records for members and providers, ensuring timely updates.
Promoted to Cost Recovery Specialist due to exceptional performance and expertise.
Handled claims processing for Guardian Insurance, enhancing operational efficiency.
Managed incoming mail and coordinated the scanning of claim forms for processing.
Experience
5-7 Years
Level
Senior
Education
AAS-HIT
Lead Dental Claims Processor Resume
Headline : With 7 years of specialized experience in dental claims processing, I excel in managing complex claims, ensuring compliance with industry regulations, and optimizing workflows for improved efficiency. My commitment to precision and service excellence drives my ability to enhance claim accuracy and foster productive relationships with insurance providers.
Skills : Facets Claims Management System, Claims Adjudication Software, Macess Claims Processing System, Office Technology Proficiency, Accurate Data Entry And Management, Claims Collections And Follow-up
Description :
Managed the processing of dental claims, ensuring compliance and accuracy in all submissions.
Secured incoming dental claims for multiple insurance providers while maintaining high standards.
Conducted thorough analysis of claims to meet quality and productivity targets.
Reviewed claims meticulously to ensure all procedures and codes were correct.
Participated in processing both national and international dental claims, ensuring timely adjudication.
Verified electronically submitted claims for accuracy and completeness.
Coordinated with examiners and technicians for efficient processing of complex claims.
Experience
5-7 Years
Level
Consultant
Education
AS in HIT
Dental Claims Processor Resume
Summary : Accomplished Dental Claims Processor with a decade of experience in managing and adjudicating dental claims. Expert in ensuring compliance with regulatory standards while optimizing claims processing workflows. Proven track record in enhancing operational efficiency and fostering strong collaborations with insurance providers to improve service delivery and patient satisfaction.
Reviewed and adjudicated dental claims with a focus on accuracy and compliance with insurance policies.
Enhanced claims processing efficiency by developing streamlined procedures for documentation and verification.
Responded to customer inquiries regarding claims status and insurance coverage, ensuring excellent service.
Maintained detailed records of claims processed and communicated updates to relevant stakeholders.
Collaborated with dental providers to resolve discrepancies and ensure timely claim resolution.
Trained new staff on claims processing protocols and software systems.
Generated and analyzed reports to assess claims trends and identify areas for improvement.
Experience
7-10 Years
Level
Management
Education
AAS in HIT
Fresher Dental Claims Processor Resume
Objective : Eager and detail-oriented individual with two years of experience in dental claims processing. Skilled in reviewing and validating claims while ensuring compliance with regulatory standards. Passionate about enhancing operational efficiency and delivering high-quality service to patients and providers. Ready to contribute to a dynamic team and support streamlined claims management.
Processed dental claims by independently reviewing patient claims and entering data into the system.
Examined and verified patient dental claims for accuracy and compliance.
Work with billing departments to resolve payment issues.
Ensured billing coding compliance with established performance standards.
Addressed customer inquiries regarding claims with a focus on superior service.
Tracked and processed dental claims for multiple insurance providers.
Communicated with dental offices to clarify claim information and resolve pending reports.
Experience
0-2 Years
Level
Fresher
Education
AS in HIT
Dental Claims Processor Resume
Summary : With a decade of extensive experience in dental claims processing, I have honed my ability to efficiently verify, adjudicate, and manage complex claims. My expertise in regulatory compliance and process optimization directly enhances operational accuracy and patient satisfaction. I am dedicated to fostering strong relationships with insurance providers to streamline claims processing and improve service delivery.
Skills : Proficient In Claims Adjudication And Management, Documentation Skills, Problem Solving, Communication Skills, Time Management, Regulatory Compliance
Description :
Efficiently processed DHMO claims, serving as a mentor and subject matter expert for claims-related inquiries.
Collaborated closely with dental consultants to ensure accurate claims processing.
Managed DHMO monthly capitation checks and handled claims adjustments, ensuring compliance with industry standards.
Utilized multiple systems for claims processing, enhancing operational efficiency.
Processed claims for Medicaid and commercial dental insurance companies, ensuring adherence to regulations.
Ensured the use of correct ADA codes to maintain compliance and accuracy.
Trained team members in new HIPAA regulations and best practices for claims processing.
Experience
10+ Years
Level
Executive
Education
AAS HIT
Senior Dental Claims Processor Resume
Summary : With 10 years of comprehensive experience in dental claims processing, I excel in verifying and adjudicating claims while ensuring strict compliance with industry regulations. My expertise in process optimization and collaboration with insurance providers enhances claim accuracy and operational efficiency, ultimately improving patient outcomes and service delivery.
Processed dental insurance claims using Dentrix software, ensuring compliance with regulations.
Managed a caseload of over 300 clients each quarter, maintaining high accuracy and efficiency.
Utilize claims processing software efficiently and accurately.
Investigated and resolved discrepancies in claims by obtaining necessary documentation.
Reviewed claims and contacted dental providers for additional information to expedite processing.
Addressed customer inquiries and concerns promptly, enhancing service satisfaction.
Trained new team members on claims processing procedures and software usage.
Experience
7-10 Years
Level
Senior
Education
AAS-HIT
Dental Claims Processor Resume
Objective : Accomplished Dental Claims Processor with 5 years of experience in managing and processing dental claims efficiently. Proficient in ensuring compliance with industry regulations, optimizing workflows, and enhancing claim accuracy. Dedicated to providing exceptional service and support to patients while collaborating effectively with insurance providers to resolve claims issues.
Skills : Billing Procedures, Claim Denial Management, Insurance Verification, Data Entry, Customer Service, Patient Records Management
Description :
Developed expertise in claims coding and processing, ensuring accurate information for payment eligibility.
Conducted thorough research and analysis of claims discrepancies to facilitate resolution.
Provided comprehensive claims support by reviewing, investigating, and adjusting claims as necessary.
Collaborated with insurance providers to clarify claims issues and streamline processing.
Ensured compliance with industry regulations and organizational policies in all claims activities.
Utilized software tools to track and manage claims efficiently.
Participated in training sessions to enhance claims processing skills and knowledge.
Experience
2-5 Years
Level
Freelancer
Education
AAS in HIT
Dental Claims Processor Resume
Objective : Proficient Dental Claims Processor with two years of focused experience in managing and validating dental claims. Skilled in ensuring adherence to regulatory standards and enhancing claims accuracy through effective communication with insurance providers. Passionate about optimizing claims processes to improve patient service and operational efficiency.
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