Health and Dental Claims Analyst

The Health and Dental Claims Analyst is responsible for reviewing, analyzing, and processing health and dental insurance claims. The role ensures that claims are adjudicated accurately and in accordance with policy provisions, guidelines, and regulatory requirements. The ideal candidate will have strong analytical skills, attention to detail, and knowledge of health and dental benefit plans

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Key Responsibilities:

• Review and analyze incoming health and dental claims for accuracy and eligibility.
• Ensure claims comply with policy coverage, terms, and regulatory standards.
• Investigate and resolve discrepancies or inconsistencies in submitted claims.
• Apply appropriate fee schedules, adjudication rules, and coding practices (ICD, CPT, ADA codes).
• Communicate with healthcare providers, policyholders, and internal departments for additional information as needed.
• Process approvals or denials in the claims management system.
• Maintain proper documentation and audit trail of claims decisions.
• Monitor and report trends or issues related to claims processing.
• Stay updated with changes in insurance policies, coding, and compliance regulations.
• Support audits, compliance checks, and quality assurance reviews.
  
  
  

Qualifications:

• Bachelors degree in Healthcare Administration, Business, or a related field (preferred).
• 13 years of experience in claims processing, health insurance, or dental benefits.
• Knowledge of ICD-10, CPT, ADA codes, and healthcare reimbursement systems.
• Familiarity with healthcare regulations such as HIPAA.
• Proficient with claims adjudication systems and Microsoft Office tools.
• Strong attention to detail, analytical and organizational skills.
• Excellent written and verbal communication skills.