Supervisor Claims Processing

 

DELTA DENTAL OF CALIFORNIA, a proven leader in the healthcare industry, is the state?s largest dental health carrier.  Together, the holding company members represent one of the largest dental benefits systems in the country, with 21 million enrollees.  At this time, PMI, an affiliate of Delta Dental has an opening for a

Supervisor Claims Processing

.

 

PURPOSE

 

To provide overall supervision for all specialty care referrals (pre-authorization) personnel; ensure timely and accurate processing of specialty care referrals.  To coordinate, recommend and implement necessary system changes to meet client and PMI needs

 

FUNCTIONS

 

1) Provides overall supervision for the claims processing, specialty care referrals, and data entry clerks staff. Monitors daily work flow and reviews weekly reports to ensure that departmental goals are met.  Approves specialty care referrals to providers.  Establishes policies and procedures regarding specialty care referrals, claims processing and data entry. Communicates regularly with personnel at all levels within PMI/Delta as well as providers, enrollees, groups/clients regarding claim payment issues and benefit determinations.

 

2) Oversees the planning and requirements definition phases for new  system applications needed to accommodate new benefit designs, DMHC requirements, reports, and any other objectives intended to improve efficiency and minimize costs.  Works closely with IS in the planning, development and testing phases of new system applications needed for implementation.

 

3) Provides management with relevant data and reports regarding specialty care referrals and statistics.  Provides written communication to other departments as needed regarding specialty care referrals and performance issues.

 

4) Oversees the evaluation and resolution of sensitive issues regarding new groups and high profile groups for specialty care referrals.

 

 

GENERAL REQUIREMENTS AND/OR MINIMUM EDUCATION REQUIREMENTS

 

?  Advanced knowledge of claims systems, preferred

?  Three years dental care experience, Health Maintenance Organization or Health Insurance experience

?  Claims/specialty care referrals processing experience

?  Extensive knowledge of Excel and Word

?  BA/BS in Business Administration or similar, preferred

?  Knowledge of Microsoft Access, preferred

?  Intermediate AS/400 query knowledge, preferred

?  Strong  oral/written communication skills

 

YOU CAN?T BEAT OUR BENEFITS!!  We offer competitive pay and a company paid benefits package. 

 

TO APPLY:on line at :  www.deltadentalca.org and click on jobs 

 

 

In connection with your application for employment with Delta Dental of California and its? related companies, please note that any offer of employment made to any applicant will be contingent upon the satisfactory results of a background check. Such background check may include, but is not limited to, an investigation of credit worthiness, a check of references, employment and education verification, a check of criminal records and/or any other investigations as permitted by law.

 

NO PHONE CALLS PLEASE We are an Equal Opportunity Employer, M/F/D/V.