Dental Insurance Claims Specialist

Do you know your way around dental insurance claims, EOBs, and insurance carriers? Are you the person who can look at an unpaid claim, figure out why it wasn’t paid, and know exactly what needs to happen next?

We’re looking for an experienced Dental Insurance Claims Specialist to join our team and help ensure orthodontic insurance claims are being worked accurately, efficiently, and consistently. This role is ideal for someone with hands-on dental billing and insurance experience who enjoys problem-solving, investigating unpaid claims, and keeping accounts on track.

What You’ll Do

• Analyze and follow up on unpaid orthodontic insurance claims that are 30+ days old.

• Contact insurance carriers to determine the reason for non-payment and take the appropriate action to resolve the claim.

• Review and interpret Explanation of Benefits (EOBs), financial screens, insurance reports, and collection reports.

• Re-file eligible claims and make corrections as needed.

• Update insurance policy information and estimated insurance portions based on information received from insurance carriers.

• Maintain accurate account information and make necessary insurance adjustments.

• Review and resolve tickets assigned to the OIS Call Center.

• Communicate daily with the OIS Account Manager regarding outstanding issues, carrier inquiries, and requests requiring additional office assistance.

• Provide a daily report to the OIS Account Manager outlining claim activity, issues, and items needing follow-up.

• Stay organized while managing multiple accounts, claims, insurance carriers, and priorities.

What We’re Looking For

Required:

• 2–4 years of hands-on dental billing and dental insurance experience.

• Experience working dental or orthodontic insurance claims from submission through resolution.

• Strong understanding of dental insurance processes, claim denials, EOBs, eligibility, benefits, and insurance follow-up.

• Ability to investigate unpaid claims and determine the appropriate next steps.

• High school diploma or equivalent.

• Strong computer skills, including Microsoft Outlook, Word, and Excel.

You’ll Be Successful in This Role If You Are:

• A problem solver who enjoys figuring out why a claim wasn’t paid.

• Detail-oriented and able to catch discrepancies in insurance and account information.

• Persistent when following up with insurance carriers.

• Organized and able to prioritize a high volume of claims and requests.

• Professional and confident when communicating with insurance carriers, account managers, and dental offices.

• Comfortable working independently while also knowing when an issue needs to be escalated.

• Able to remain calm and professional when dealing with challenging situations.

Communication & Reasoning Skills

The ideal candidate can clearly communicate with insurance carriers, customers, account managers, and dental offices. You should be able to analyze information, interpret insurance documentation, resolve practical problems, and explain next steps in a clear and professional manner.

Experience That Matters

We are specifically seeking someone with dental billing and dental insurance experience. Experience with orthodontic billing, insurance claims, EOBs, claim follow-up, denials, re-filing claims, and insurance account resolution is highly preferred.

If you know dental insurance, enjoy solving claim issues, and take pride in getting unpaid claims resolved, we’d love to hear from you.