Claims Auditor 

Responsibilities

• Verify that the patient information on the claim forms is accurate and matches the data in the system; including patient/member name, social security 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

Compensation and benefits

Delta Dental provides an excellent compensation and benefits package including medical, dental, vision, life & disability insurance, paid vacation, sick leave, continuing education, and 401k. More information about benefits and company culture is available on our Careers page.