LTHC एक वेलनेस और खेल-केंद्रित कंपनी है, जो Academia LIFT के पीछे है—यह बॉडीबिल्डिंग, व्यायाम और स्वास्थ्य पर केंद्रित फिटनेस और प्रशिक्षण का स्थान है। कंपनी का काम ग्राहक अनुभव पर केंद्रित है, जिसमें सुविधा और स्थान के साथ संवाद से लेकर खिलाड़ियों, मनोरंजन के लिए व्यायाम करने वालों और पेशेवरों को शारीरिक स्वास्थ्य, मानसिक स्वास्थ्य तथा प्रतिस्पर्धी प्रदर्शन के लक्ष्य हासिल करने में सहायता करना शामिल है। LTHC इसी क्षेत्र में अतिरिक्त स्थानों को अधिग्रहित करने या विकसित करने का भी लक्ष्य रखती है।
Dental Claims Examiner I–IV
Process and adjudicate dental claims for Excellus Health Plan, including adjustments, escalations, and compliance tasks. Responsibilities expand across four levels, from routine processing to complex adjustments, peer training, and analytical support.
विवरण
- Process, adjudicate, adjust, and research claims ranging from straightforward to complex.
- Verify member eligibility, enter claims, match members and providers, and process claims.
- Spot trends affecting quality, claim inventory, customer experience, or risk, and escalate issues for review.
- Apply departmental procedures, company policies, and member, group, and provider contracts and riders when processing claims.
- Gather missing information through system-generated letters or phone calls.
- Work with internal teams and internal and external customers.
- Take part in learning about regulations, systems, procedures, and role-related skills.
- At Level II, process complex claims and limited adjustments, identify root causes, recommend solutions, and support other processors.
- At Level III, process high-profile claims and all adjustments, train peers, and resolve escalated issues.
- At Level IV, manage mass adjustment and scripting processes, support analytical work, handle high-profile adjustments, mentor peers, and facilitate meetings.
- Protect member privacy and integrity, uphold quality standards, and follow the Corporate Code of Conduct.
- Carry out other duties assigned by management.
आवश्यकताएँ
- High school diploma or equivalent.
- Relevant customer service or claims processing experience is preferred.
- Ability to keep developing skills for career growth.
- Basic computer skills, including navigating a Windows environment.
- Ability to work in multiple programs and applications simultaneously.
- Effective self-management skills.
- Ability to multitask and efficiently resolve moderately complex claims and simple adjustment transactions.
- For B Version, a valid New York State Independent Adjuster License and ongoing renewal maintenance are required.
- Level II: At least one year of progressive experience in claims processing, customer service, or insurance-related roles.
- Level II: Ability to analyze and resolve complex situations and transactions.
- Level II: Understanding of coordination of benefits (COB) determinations.
- Level II: Strong reasoning and problem-solving skills.
- Level III: At least three years of progressive experience in claims processing, customer service, or insurance-related roles.
- Level III: Strong business acumen.
- Level III: Ability to work independently with a high degree of accuracy.
- Level IV: At least five years of progressive experience in claims processing, customer service, or insurance-related roles.
- Level IV: Demonstrated ability to mentor and coach junior specialists.
- Ability to hear, understand, and speak clearly on the phone, with or without a headset.
- Ability to work seated or standing at a workstation, using a computer, keyboard, mouse, and/or phone for three or more hours at a time.
- Ability to travel within the Health Plan service region for meetings or training as needed.
- Regular and reliable attendance is required.
लाभ
- Group health and/or dental insurance
- Retirement plan
- Wellness program
- Paid time away from work
- Paid holidays
- Possible remote work on a case-by-case basis