The Claims Supervisor oversees daily claims operations, including staff supervision, workflow management, and ensuring accurate and timely claim processing. They are responsible for performance monitoring, training staff, and identifying process improvement opportunities to meet contractual benchmarks.
The Utilization Management Clinical Dental Processor evaluates dental service requests by reviewing x-rays and documentation to determine medical necessity based on clinical criteria. They ensure compliance with client contracts and maintain high productivity standards while documenting approval decisions.
The specialist will handle 40-60 inbound calls daily, addressing inquiries of routine to moderate complexity regarding dental benefits for Medicaid recipients, while accurately capturing and updating member information in systems. They must investigate and collaborate with internal teams to ensure issues are resolved, providing compassionate support and expert guidance to members accessing essential dental care services.
The specialist will handle 40-60 inbound calls daily, addressing inquiries of routine to moderate complexity regarding dental benefits for Medicaid recipients and ensuring accurate system data capture. They must investigate and collaborate with internal teams to resolve member issues, ensuring follow-up until a solution is provided.
