Claims Specialist - Saskatoon, Canada - Saskatchewan Blue Cross

Saskatchewan Blue Cross

Verified Company

Saskatoon, Canada

1 week ago

Posted by:

Sophia Lee

beBee Recruiter

Description

Saskatchewan Blue Cross, one of Saskatchewan's Top Employers, is currently recruiting for a permanent full-time_ Claims Specialist (Dental) _to join our Health & Dental Claims Department.

This position offers the flexibility to work in-office or participate in hybrid options based in our Saskatoon or Regina office.

JOB FUNCTION

WHY CHOOSE SASKATCHEWAN BLUE CROSS?

We're driven by a mission to empower communities on their journey to whole health and wellness and have a lot of exciting things ahead of us.

We're improving our members' experiences through investment in our people, technology, services, and products.

When you join our team, you're joining an organization where employees are valued, recognized for their contributions, and empowered to make us stronger.

The wellbeing of our employees, our members, our partners, and our communities is at the heart of our operations.

Our industry is evolving fast, and so are we We're looking for people who:

Share our values
Believe that creating great experiences is totally within their control
Collaborate and always set others up for success
Build positive relationships and an understanding of what people's needs are
See solutions and possibilities (not problems)
Are simply outstanding at what they do

DUTIES & RESPONSIBILITIES

Accurately and efficiently enter and adjudicate dental claims and predeterminations based on the contract provisions and internal policies and procedures to ensure timely payment for our dental providers and members
Review dental treatment plans, accident reports, and xrays
Process pended electronic dental claims and electronic dental reversals
Create and maintain effective working relationships with dental providers and consultants
Respond to telephone and/or written inquiries from customers and service providers regarding all aspects of benefits and claims assessment
Explain benefit payments and exclusions to plan members and providers of service
Research and compile information from various sources to resolve inquiries, including consulting with Claims Analysts or other staff as appropriate
Follow through to ensure effective and efficient resolution of problems
Participate in the Claims Quality Assurance Program
Monitor individual production to ensure turnaround expectations are met
Suggest opportunities for improvements in workflows and processes
Remain current with product knowledge
Act as a key leader, resource, and liaison within and outside the department and organization
Train, mentor, and provide informational and procedural support to the Claims Analysts
Stay abreast of and communicate product, industry, system, and contract changes
Perform other duties as required

QUALIFICATIONS & SKILLS

Completion of a Dental Assistant Certification from a recognized institution and a minimum of 13 years experience as a dental assistant
Proven knowledge of CDA dental codes, dental terminology, clinical procedures and nomenclature and the ability to interpret dental xrays
Previous experience processing dental claims, and/or other insurance experience would be definite assets
Well organized, detail oriented, and a desire for continuous learning
Exceptional analytical, problemsolving, and decisionmaking capabilities
Demonstrated ability to work to deadlines and manage fluctuations in workload
Possess strong keyboarding skills
Established ability to learn new software programs
Working knowledge of Microsoft Office 36
Effective listening, interpersonal, and problemsolving competency
Excellent verbal and written communication skills
Ability to work independently, as well as in a group environment
Must be legally entitled to work in Canada on an unrestricted basis