Professional Review Clinical Specialist

Other Jobs To Apply

Position Summary

Seeking Dental Assistant to review claims with the submitted diagnostic material to make proper benefit determinations based on group contracts and DeltaUSA and departmental established guidelines/policies. Responsible for clearing up queues on a daily basis and to pend appropriate claims for additional information. Refers claims to dental consultants for review.

Location

Candidates located more than 1 hour outside of our corporate office in Roanoke, VA and residing in the following states may be considered for remote work: FL, GA, ID, MD, NC, NE, SC, TN, VA, WI, WV

Essential Functions

  • Reviews diagnostic material (i.e. x-rays, periodontal charting, etc.) to determine appropriate benefits.
  • Adjudicate claim benefit review requests in a timely manner.
  • Refers claims to dental consultant for review when diagnostic materials do not appear to support the procedure requested.
  • Follows DeltaUSA guidelines and departmental guidelines/policies for claims processing.
  • Works in team concept with the CCU and other departments within Delta Dental.
  • Maintain accuracy and production numbers to meet department expectations.
  • Audited to ensure KPI’s are met monthly.

Qualifications/Education/Experience

  • Dental Assistant or Dental office manager.
  • Knowledge interpreting dental x-rays.
  • The ability to follow established procedures with moderate decision-making.
  • Extensive computer knowledge/skills.
  • Strong interpersonal and communication skills.
  • The ability to focus for long periods of time.
  • A positive attitude with ability to adapt to change and learn new things.

Physical Demands and Work Environment:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Physical demands: While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk or hear. Use of hands is required for such technological devices such as a computer, telephone and others. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. The employee will be required to travel (sometimes long distances) to attend required meetings.
  • Work environment: The work is limited to the office environment with occasional trips to other office facilities or locations necessitating walking outdoors or driving. The noise level in the work environment is usually minimal.
Back to blog

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...