Dominion National Hiring for Claims Specialist at Remote Full Time

Dominion National, a rapidly growing and leading provider of dental and vision benefits has an exciting opportunity for an experienced Claims Specialist.

The Claims Specialist will investigate claims, determine liability, and review information related to claims to ensure resolution of claims concerns and inquiries. The Claims Specialist is also responsible for reviewing dental claims after they are submitted to make sure that the proper filing procedures have been followed.

Essential functions include but are not limited to:

• Process claims accurately in accordance with the claims processing system and other department guidelines.
• Investigate and resolve claim concerns; reverse and reprocess claims as necessary.
• Respond to specialized claims inquiries from patients and providers.
• Determine liability as it relates to COB claims.
• Review provider and/or member status to determine eligibility, participation, primacy, and correct reimbursement level, which may include re-pricing.
• Ensure that appropriate follow-up to claims inquiries/requests is complete and timely.
• Maintain current knowledge of Claims policies and procedures.
• Performs other duties as assigned.