Claim Processor/Adjustor
Reviewed 9.2025
Delta Dental of Illinois
Job Description
JOB TITLE: Claim Processor/Adjustor
DEPARTMENT: Claims
REPORTS TO: Manager, Claims
PAY STATUS: Non-Exempt
OVERVIEW OF POSITION: The Claim Processor/Adjustor is responsible for providing service to the DDIL client
base through accurate processing of dental claims as well as troubleshooting and resolving all types of dental
claim related inquiries.
DUTIES & RESPONSIBILITIES:
Investigate and process claims according to established business rules that have failed computer program
edits
Provide guidance in claims processing requiring advanced technical and dental knowledge
Meet daily/weekly claim production goals as set by the ITL
Complete and maintain daily audit production logs
Accurately completes special projects assigned within specified time frame
Access EPHI following the current guidelines as established at the company-wide and department levels.
Maintain regular and punctual attendance
Perform other job-related duties as assigned (Professional Review, Appeals Review, E-Forms)
Update ITL or Manager regarding daily status of assigned reports by timeframe established by ITL or
Manager.
Encouraged to work overtime according to business need.
Accesses EPHI following the current guidelines as established at the company- wide and department levels.
Maintains regular attendance and punctuality.
Performs other job-related duties as assigned.
EXPERIENCE & QUALIFICATIONS:
Excellent oral and written communications skills. Strong computer keyboard skills. Knowledge of insurance
reimbursement practices, i.e. processing policies, deductibles, maximums, Coordination of Benefits (COB)
and dental terminology.
Ability to work independently and execute multiple tasks simultaneously
Excellent attendance and punctuality record.
Claim Processor/Adjustor
Reviewed 9.2025
While not a requirement for the position, a preference is given to those who:
can speak Spanish fluently, or
can make diagnostic determinations based on provider claim narratives, dental photos and radiographs
Employee Signature Date
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