Claims Examiner at Delta Dental of New Jersey

Parsippany-Troy Hills, New Jersey, United States -

Full Time

Start Date

Immediate

Expiry Date

21 Jan, 26

Salary

22.05

Posted On

23 Oct, 25

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Adaptability-Flexibility, Communication Skills, Computer Skills, Customer Focus, Dependability, Job Knowledge, Productivity, Quality, Teamwork, Attention to Detail, Organizational Skills, Analytical Skills, Proofreading Skills, Research Skills, Troubleshooting Skills

Industry

Insurance

Description

About Us Delta Dental of New Jersey and Delta Dental of Connecticut are proud to be leaders in the dental insurance industry, offering a wide range of plans to meet the needs of individuals and employers alike. As New Jersey’s largest dental coverage provider, we are committed to delivering high-quality, cost-effective solutions designed to meet the diverse needs of our customers and our team is growing. In Connecticut, Delta Dental of Connecticut, Inc. provides fully insured dental coverage, while Delta Dental of New Jersey administers self-funded dental benefit programs. We proudly serve over 1.7 million individuals through more than 1,800 groups, including commercial, school board, and government programs. Since 1969, Delta Dental has been at the forefront of innovation, offering programs that control costs while ensuring the highest level of benefits. As a member of the national Delta Dental Plans Association, we provide national dental coverage to over 75 million people across 139,000 groups. Our commitment to excellence is reflected in our prestigious Standard & Poor’s “A+” rating for financial strength. Join us and be a part of a trusted company with a rich history of delivering quality dental benefits to millions. We value our associates and support everyone with learning and development, active wellness and diversity initiatives, and volunteer opportunities at causes that you care about. About the Position Our Claims Examiners are provided with established company guidelines and examine and adjudicate dental claims using these guidelines, with expected levels of quality and productivity. This is a full time hybrid position, Monday through Friday, 8 am to 4:30 pm, working in the office Tuesday and Wednesday, and remote Monday, Thursday and Friday. During the first five weeks, you will attend full time, paid training which follows the same hybrid schedule. This position starts at $22.05 per hour and is benefits-eligible. The start date of this position is December 8th, 2025. Essential Functions & Responsibilities * Accesses systems and keys claim data and other information and notations from work queues. Suspends, routes and adjudicates claims and performs research as required. Also, inputs fee filing data, as required * Creates and processes claims for pre-treatment estimates with payments. * Maintains and updates subscribers files with information obtained through inquiries and submitted claims and documents, i.e., family on hold codes applied or removed, student status deferred, addresses updated. Reports file discrepancies to management. * Responsible for researching and retrieving all documentation and resolving all claims in question, including student documentation, provider research, some coordination of benefits, diagnostics materials, etc. * Understands rejects and applies appropriate RFS codes as well as processing policies on applicable claims. * Requests information from providers and subscribers through telephone contact or written correspondence. * Resolves claims related system generated error and adjustment reports. * Supports and participates in completing claims related projects. * Acquire necessary skills through in-house training for Claim Examiner II position. Achieve Level II position within 36 months from start of Claims Examiner I. * When necessary, refers inquiries to management, dental consultants or appropriate outside organizations. * Provides management with required production figures as requested. * Other duties as assigned Essential Qualifications Competencies Adaptability-Flexibility Communication Skills Computer Skills Customer Focus Dependability Job Knowledge Productivity Quality Teamwork Technical and Functional * Personal computer skills with the ability to type 25 words per minute * Possess the ability to use Microsoft Word and Excel * Excellent written and oral communication skills * Ability to research and troubleshoot problems * Demonstrate good analytical and proofreading skills * Attention to detail * Good organizational skills Key Performance Indicators * Meet-exceed CPH of 30 or above * Maintain TQM of 99% or higher Required Physical Abilities The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Ability to sit and perform extensive close keyboard and PC work * Ability to walk, talk or hear * Occasionally required to stand and reach with hands and arms Working Environment * Ability to meet deadlines and attendance standards. * The noise level in the work environment is usually moderate. * This classification will be required to sign a confidentiality agreement. Experience, Education and Certifications Required Experience Required * 1-3 years claims processing or related service experience * Dental Assistant education/experience preferred Required Educational Level * Requires high school diploma or equivalent.

Responsibilities

Claims Examiners examine and adjudicate dental claims according to established company guidelines. They are responsible for processing claims, maintaining subscriber files, and resolving discrepancies.