Claims Examiner (US)

Claim Processor/Adjustor Reviewed 9.2025 Delta Dental of Illinois Job Description JOB TITLE: Claim Processor/Adjustor DEPARTMENT: Claims REPORTS TO: Manager, Claims PAY STATUS: Non-Exempt OVERVIEW OF POSITION: The Claim Processor/Adjustor is responsible for providing service to the DDIL client base through accurate processing of dental claims as well as troubleshooting and resolving all types of dental claim related inquiries. DUTIES & RESPONSIBILITIES:  Investigate and process claims according to established business rules that have failed computer program edits  Provide guidance in claims processing requiring advanced technical and dental knowledge  Meet daily/weekly claim production goals as set by the ITL  Complete and maintain daily audit production logs  Accurately completes special projects assigned within specified time frame  Access EPHI following the current guidelines as established at the company-wide and department levels.  Maintain regular and punctual attendance  Perform other job-related duties as assigned (Professional Review, Appeals Review, E-Forms)  Update ITL or Manager regarding daily status of assigned reports by timeframe established by ITL or Manager.  Encouraged to work overtime according to business need.  Accesses EPHI following the current guidelines as established at the company- wide and department levels.  Maintains regular attendance and punctuality.  Performs other job-related duties as assigned. EXPERIENCE & QUALIFICATIONS:  Excellent oral and written communications skills. Strong computer keyboard skills. Knowledge of insurance reimbursement practices, i.e. processing policies, deductibles, maximums, Coordination of Benefits (COB) and dental terminology.  Ability to work independently and execute multiple tasks simultaneously  Excellent attendance and punctuality record. Claim Processor/Adjustor Reviewed 9.2025 While not a requirement for the position, a preference is given to those who:  can speak Spanish fluently, or  can make diagnostic determinations based on provider claim narratives, dental photos and radiographs Employee Signature Date Originally posted on Himalayas Claims-Processing, Claims-Examination, Dental-Claims, Insurance-Claims, Claims-Adjuster, Claims-Examiner, Insurance-Claims-Examiner, Claims-Examining, Claims-Reviewer