Claims Representative - Remote

Entry-Level Dental Claims Representative – Job Description

SUMMARYThe Dental Claims Representative is responsible for reviewing and processing dental claims in accordance with plan benefits, eligibility, and internal policies. This entry-level role is ideal for individuals beginning their career in healthcare operations, offering hands-on experience in dental claims processing and exposure to industry-standard tools and practices. Representatives will be trained to accurately adjudicate claims, identify discrepancies, and ensure timely resolution. Success in this role is measured by accuracy, productivity, and a commitment to learning and development.

RESPONSIBILITIES

• Review and process dental claims using established procedures and guidelines.
• Verify member eligibility and plan benefits to determine appropriate claim outcomes.
• Accurately enter and update claim information in the system.
• Identify and flag claims requiring additional documentation or review.
• Collaborate with team members and supervisors to resolve claim issues.
• Participate in training sessions and team meetings to build knowledge and skills.
• Utilize virtual tools such as Outlook, Webex, and internal platforms to communicate and stay connected with team members and leadership.
• Maintain confidentiality and adhere to HIPAA and other regulatory requirements.

QUALIFICATIONS

• High school diploma or equivalent required; associate’s or bachelor’s degree preferred.
• Strong attention to detail and a willingness to learn.
• Basic understanding of dental terminology and/or RDA/RDH is a plus, but not required.
• Proficient in Microsoft Office applications, especially Outlook and Excel.
• Strong written and verbal communication skills.
• Ability to work in a fast-paced, deadline-driven environment.
• Excellent organizational and time management skills.
• Customer service or administrative experience in a healthcare or dental setting is a plus.

GROWTH OPPORTUNITIES

• This role offers a clear path for advancement into more specialized or senior claims roles, including opportunities to:

• Support cross-functional projects.
• Train as a subject matter expert (SME).
• Participate in quality improvement initiatives.
• Gain exposure to multiple claims platforms and processes.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.