Creates and maintains accurate records necessary for claims processing and adjustments of claims. This role also conducts research on the claims files as needed. The File Maintenance Specialist further partners with Claim Examiners, Service Specialists, Supervisors, Group Administration, Sales and other departments to help with advanced research and questions.

At Delta Dental of Washington our vision is that all people can enjoy good oral and overall health, with no one left behind. We succeed because of a shared commitment to a set of values that guide everything we do – for our customers, for our communities, and for each other. We are Accountable. We lean in with Courage. We stay Curious. We are Inclusive. We act with Integrity.

We offer a highly competitive medical, dental and vision plans as well offering a generous 401k match and all employees start accruing vacation and sick time from their very first day. We empower employee development through our tuition reimbursement plan, professional development plans, and employee-led communities.

The pay range for this position in Eastern Washington varies between $42,000.00 - $63,000.00. Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza Corp. intends to offer the selected candidate a base pay within this range, dependent on job-related, non-discriminatory factors such as experience. Base pay will also be adjusted based on the candidate's geographic location.

Essential Responsibilities include the following: The list of responsibilities listed is not intended to be comprehensive. Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza reserve the right to change the responsibilities at any time with or without notice.

• Claim adjustments: including all aspects of claims
• Member updates: including accumulators, deductibles, maximums, incentive levels, clinical history, history transfers, etc. for new groups or group changes
• Projects: including ortho reset ups, provider changes, groups changes and updates, etc.
• Documentation updates for reports, projects and workarounds
• Daily/weekly Reports
• Project tickets from several different departments
• User acceptance testing
• Write up and submission requests for Accounts Payable Checks
• Priority and Out of Country Claim Submissions
• Serve as a resource and SME to supervisors, service specialists, support team, claims specialists, as well as other departments for research and assistance of claim problems, adjustments, DDWA policy, group problems, system problems, etc.
• Process ready to pay claims
• Help identify system problems, group set up errors, etc. and report to our Operations Analysts
• Outreach to provider offices, members, law firms for additional information needed to process a claim or update a member file
•  Process subrogation requests

The experience, skills, and education needed to succeed in the position are outlined below. These requirements are representative of the knowledge, skills, and abilities required to successfully perform the essential functions of the role.

• Friendly and professional communication skills
• Detail oriented with consistent follow-up practices and customer focus
• Ability to understand and explain Delta Dental of Washington claim information required
• Demonstrated record of being organized and able to meet deadlines
• Is a standout colleague who is willing to go above and beyond to make sure the work is accomplished timely and accurately
• Takes the initiative to identify issues and report them quickly
• A strong desire to perform well and continue to learn

Travel:

This position requires occasional travel. 

Operational Demands:

The operational demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. To request disability accommodation please contact your manager or HR Business Partner.

• Ability to sit and work at a computer keyboard for extended periods of time.
• Must utilize visual acuity, speech and hearing, hand and eye coordination and manual dexterity necessary to operate a computer and office equipment.

Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

We are committed to the highest standards of information security and HIPAA compliance, ensuring the confidentiality, integrity, and protection of all data. All staff are expected to support this commitment by following relevant policies.