You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a Claims Resolution Specialist who will be responsible for handling complex member issues, reviewing dental claims and records, coordinating with providers and clinical teams, and explaining complex information clearly. The primary goal is to support members while protecting customer experience and ensuring compliance with relevant guidelines.

Key Responsibilities

• Handle complex member issues and provide appropriate resolutions.
• Review dental claims and records to assess correct processing.
• Coordinate with providers and clinical teams for necessary documentation.
• Explain technical insurance and dental information in an easy-to-understand manner.
• Support members and maintain a positive customer experience.
• Monitor trends and identify potential compliance concerns.
• Collaborate with various departments to identify process improvements.

Qualifications

• Dental clinical and claims experience.
• Understanding of dental benefits and claims.
• Compassionate member communication skills.
• Strong communication skills.
• Technology and remote work skills.
• Relevant clinical or coding credentials are preferred, such as RDA, CDA, or dental coding certifications.
• Experience in escalation and customer experience management.

Skills

• Technical skills: Comfortable working with CRM platforms, Microsoft Office.
• Soft skills: Excellent written and verbal communication, patient and empathetic communication with members.

Additional Requirements

• 100% remote work with a Monday-Friday schedule, 8:30 am-5:30 pm CST.
• Ability to utilize clinical dental expertise without direct patient care.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

Any required state or Joint Commission training is compensated at the state or local minimum wage rate.

^*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients