Claims Auditor 

Duties and responsibilities:

• Verify that the patient & dentist information on the claim forms is accurate and matches the data in the system; including patient/subscriber name, identification number, address, date of birth, etc.
• Ensure that the proper treatment codes are assigned to the proper tooth number(s)
• Verify the frequency of treatments to ensure proper benefit coverage
• Responsible for properly encoding claims into the system
• Ensure that most/all claims are encoded before each check run cycle’s cut off date
• Ensure proficiency with dental terminology and Delta Dental processing policies
• Verify information on claims edit reports
• Track the total number of claims received
• Generate periodic reports for quality control purposes
• Process and maintain various reports associated with each check run process
• Perform other duties as assigned by management to best meet the needs of the department

Experience and qualifications

• Must have a high school diploma or equivalent education
• Previous background or prior experience in claim processing is helpful
• Ability to work well with other people

Other

Delta Dental of South Dakota is committed to an environment that fosters joy in work. Our company culture is built on key attributes that support our overall vision, mission, and strategic goals:

• Be an advocate for Delta Dental of SD.
• Bring value to the organization.
• Demonstrate your expertise.
• Earn the trust of others.
• Take part in giving back.

As a leading employer in South Dakota, we offer outstanding benefits, an incentive bonus plan, highly competitive pay, and a culture you'll be proud to be part of.

*Disclaimer: This position description is not meant to be all-inclusive. The job itself may be subject to change, and management has the right to assign/reassign duties and responsibilities accordingly.