Role Description The Dental Claims Resolution Specialist I is responsible for entering and processing dental claims in the claims system. This role requires attention to detail, strong problem-solving skills, and the ability to follow established guidelines to ensure claims are processed accurately and on time. Compensation: Pursuant to Service Contract Act You will review claim submissions, enter claim information into the system, identify errors or missing information, and help ensure claims move through the process efficiently. Key Responsibilities - Enter dental claim information into the claims processing system from paper, portal, or fax submissions - Review claims for accuracy and correct OCR or data entry errors - Monitor and respond to questions from the claims email queue - Assist with resolving claims that fail electronic processing (EDI errors) - Track claims issues using spreadsheets to ensure claims are processed within required timelines - Research and resolve moderately complex claims issues - Follow the full claim lifecycle to ensure claims are processed and resolved properly - Communicate with internal teams to resolve claim issues when needed Work Environment - Fully remote position (U.S.-based employees only) - Work hours will be communicated during the hiring process - Company equipment and systems will be provided for performing job duties Qualifications - At least 3 years of claims processing or related experience (dental experience preferred) - Strong attention to detail and problem-solving skills - Proficiency with Microsoft Office (Excel, Word, Outlook) - Ability to work independently and as part of a team - Strong written and verbal communication skills - Ability to manage multiple tasks and adapt to changing priorities Preferred Qualifications - Dental claims processing experience - Dental office or dental assisting background - Associate degree in Business Administration or a related field - Dental or medical coding experience - Healthcare or medical call center experience Benefits - Competitive salary - Medical benefits - PTO - Holiday pay - More Company Description MPF Federal is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description OMS National Insurance Co. is a nationwide company in search of nationwide talent. We have one simple mission at OMSNIC - We are dedicated to serving and protecting oral and maxillofacial surgeons and dental professionals nationwide. If you are an experienced medical malpractice claims professional based in the U.S, and would like to join us in our mission, we invite you to apply for this remote opportunity. (Local candidates are encouraged to apply as well, and would qualify for a hybrid work schedule). Our claims analysts have direct contact with our policyholders and are regarded as trusted partners, managing an assigned caseload of claims. This includes the investigation, evaluation, and resolution of both pre-litigation and litigated matters. Essential Duties and Responsibilities: - Evaluate coverage - Assign, collaborate with, and oversee outside defense counsel - Review and analyze medical records - Investigate and evaluate issues of liability, causation, and damages, proactively moving the files toward resolution - Participate in the formulation of case strategy - Negotiate claims in a settlement posture - Evaluate indemnity and expense reserves - Prepare comprehensive claims reports - Present claims to management and for internal review - Regularly communicate with policyholders, keeping them informed of status and strategies - Timely and accurately document claim files - Help maintain claim file data for accurate reporting - Review and approve invoices General: - Contribute to departmental and company goals, initiatives and projects - May attend or participate in training and development programs - Planning and participation in Risk Management and Defense Counsel Seminars - May participate in the training and development of new hires - May participate in planning, development, and testing of technology solutions Competencies: - Strong organizational and time management skills, ability to meet deadlines - Effective written and oral communication skills to provide information in a clear and concise manner and to communicate with a variety of stakeholders - Effective analytical and critical thinking skills to analyze facts and draw conclusions to make recommendations and resolve issues - Ability to prepare robust reporting yet provide a broad scope overview and summary, when appropriate - Superior customer service skills and ability to actively listen - Strong interpersonal skills with ability to interact with policyholders, legal professionals, management, co-workers, agents, committee and board members, and external vendors - Strong mediation and negotiation skills - Microsoft Office Suite proficiency with emphasis on Word, Excel, and PowerPoint Qualifications - Bachelor’s Degree required - JD preferred but not required - Minimum 5 years’ experience in medical professional liability claims management field Requirements - Fully remote - Travel required as needed Salary $100,000-$140,000. The salary range represents the entirety of the pay grade for this role. Specific salaries will be determined using a variety of factors, including specific skills, years of experience, location, and comparison to team members already in this role. Benefits - Medical, Dental, and Vision Insurance - 401(k) - Short and Long-term disability - Life Insurance - Employee Assistance Program - Long-term incentive plan - Educational Assistance and rewards program - Paid Time Off - Paid Holidays - Paid parental leave - Home office stipend

Discover Vanderbilt University Medical Center: Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded, and your abilities challenged. Vanderbilt Health is committed to an environment where everyone has the chance to thrive and where your uniqueness is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt’s mission is to advance health and wellness through preeminent programs in patient care, education, and research. Organization: Financial Clearance 10 Job Summary: Assists in financial clearance relating to patient care with occasional guidance. Screens patients for referral to other funding resources. . KEY RESPONSIBILITIES - Obtains certification from insurance companies for all office visits. - Verifies insurance information and registers cases in tracking system. - Evaluates patient assets and liabilities to determine ability to pay. - Reviews alternatives to admission and guides patient in applying for financial assistance. - Completes pre-certification, credit applications, and other necessary paperwork. - Performs investigative and follow-up work relating to reimbursement issues. - The responsibilities listed are a general overview of the position and additional duties may be assigned. - Performs tasks to support and obtains pre-certifications from insurance companies TECHNICAL CAPABILITIES - Problem Solving (Novice): Uses critical thinking and process improvement i.e. coaches and mentors development of problem statement, describes current state, identifies root causes, creates future state, coaches and mentors development of solutions and action plans with a sustainability plan. Applies appropriate tools to address issues. - Data Entry (Novice): The ability to transcribe information from the original source into an electronic system according to written and verbal instructions efficiently and accurately. - Customer Service (Novice): A continuing focus on the needs and requirements of customers, anticipating their needs, remaining sensitive to customers while performing services for them, responsive to customer needs. - Insurance Regulatory Knowledge (Intermediate): Demonstrates knowledge of the appropriate rules and regulations for insurance policies, claims, payment and coverage. Ability to interpret and explain rules and regulations that are ambiguous or unclear. Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more. At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose. Core Accountabilities: * Organizational Impact: Performs tasks that are typically routine that may impact team's performance with occasional guidance. * Problem Solving/ Complexity of work: Utilizes some discretion and research to solve routine problems. * Breadth of Knowledge: Applies knowledge of standards, established processes and procedure that apply to your own job. * Team Interaction: Provides guidance to entry level co-workers. Core Capabilities : Supporting Colleagues : Develops Self and Others: Continuously improves own skills by identifying development opportunities.- Builds and Maintains Relationships: Seeks to understand colleagues' priorities, working styles and develops relationships across areas.- Communicates Effectively: Openly shares information with others and communicates in a clear and courteous manner. Delivering Excellent Services: - Serves Others with Compassion: Invests time to understand the problems, needs of others and how to provide excellent service.- Solves Complex Problems: Seeks to understand issues, solves routine problems, and raises proper concerns in a timely manner. - Offers Meaningful Advice and Support: Listens carefully to understand the issues and provides accurate information and support. Ensuring High Quality: - Performs Excellent Work: Checks work quality before delivery and asks relevant questions to meet quality standards. - Fulfills Safety and Regulatory Requirements: Demonstrates basic knowledge of conditions that affect safety and reports unsafe conditions to the appropriate person or department. Managing Resources Effectively : - Demonstrates Accountability: Takes responsibility for completing assigned activities and thinks beyond standard approaches to provide high-quality work/service. - Stewards Organizational Resources: Displays understanding of how personal actions will impact departmental resources. - Makes Data Driven Decisions: Uses accurate information and good decision making to consistently achieve results on time and without error. Fostering Innovation : - Generates New Ideas: Willingly proposes/accepts ideas or initiatives that will impact day-to-day operations by offering suggestions to enhance them. - Applies Technology: Absorbs new technology quickly; understands when to utilize the appropriate tools and procedures to ensure proper course of action. - Adapts to Change: Embraces changes by keeping an open mind to changing plans and incorporates change instructions into own area of work. Position Qualifications: Responsibilities: Certifications: Work Experience: Relevant Work Experience Experience Level: 2 years Education: High School Diploma or GED Vanderbilt Health is committed to fostering an environment where everyone has the chance to thrive and is committed to the principles of equal opportunity. EOE/Vets/Disabled.

Discover. Achieve. Succeed. #BeHere Location: US:WI:MENOMONEE FALLS at our WOODLAND PRIME 400 facility. This job is REMOTE. FTE: 1.000000 Standard Hours:40.00 Shift: Shift 1 8:00-430 Monday to Friday Job Summary: The Pre-Authorization Specialist is a member of the Pre-Authorization Department who is responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services. This individual determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care. The Pre-Authorization Specialist provides detailed and timely communication to both payers and clinical partners in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. Other duties as assigned. Other information: EXPERIENCE REQUIRED: A minimum of 2 years experience in hospital billing/pre-authorization or insurance verification with demonstrated knowledge of health insurance plans including: Medicare, Medicaid, HMO's and PPO's required. EXPERIENCE PREFERRED: Prior experience in a business office position with strong customer service background preferred. EDUCATION REQUIRED: High School diploma or equivalent is required. EDUCATION PREFERRED: None TRAINING REQUIRED: None TRAINING PREFERRED: None SPECIAL SKILLS REQUIRED: Exceptional customer relations skills required. SPECIAL SKILLS PREFERRED: Knowledge of online insurance eligibility systems. Excellent typing and computer skills. Familiarity with Medical Terminology. Demonstrated ability to efficiently organize work and maintain a high level of accuracy and productivity. LICENSURE REQUIRED: None LICENSURE PREFERRED: None Perks & Benefits at Froedtert Health Froedtert Health Offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following: - Paid time off - Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities - Academic Partnership with the Medical College of Wisconsin - Referral bonuses - Retirement plan - 403b - Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics - Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation. We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to share their priority consideration status with us at 262-439-1961. We maintain a drug-free workplace and perform pre-employment substance abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at 262-439-1961. We will attempt to fulfill all reasonable accommodation requests.