Claims and System Support Specialist

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Job Summary:

At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.

At Delta Dental, we celebrate our All In culture. It’s a mindset, feeling and attitude we wrap around all that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community.

Position Description

Oversees claims system configurations, claims adjudication processes, while providing operational support, resolving escalated issues, and assisting in system updates and documentation for Enterprise.

Primary Job Responsibilities:

• Participates in defining business requirements, review of Roosevelt system design, user acceptance testing, and implementation procedures, as well as evaluating and communicating the impact changes may have on various departments.

• Collaborates with Information Systems and Services teams to test and implement system updates and enhancements.

• Audits and maintains rules relating to claims processing, while analyzing and implementing rule enhancements improving the efficiency and accuracy of claims processing.

• Processes mass adjustment requests, provides summary results to customers, adjusts claims resulting in manual adjustments, documents the mass adjustment process, and educates other departments on its functionality. 

• Provides support to business users with questions or concerns related to claim adjustments and adjudication.

• Maintains Roosevelt system configurations.

• Collaborates and communicates closely across departments to organize, update, and implement procedure manuals and claim processing reference materials.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

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Minimum Requirements:

Position requires a bachelor’s degree in business administration or a related field and three years of experience administering dental benefits or planning and executing projects. Will accept any suitable combination of education, training, or experience.

The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.