Job Summary:

The Insurance Collections Specialist III serves as a senior-level collections expert responsible for resolving highly complex reimbursement issues, managing strategic payer relationships, and driving collections performance improvement. This role provides expertise, mentorship, and operational leadership to support departmental goals and maximize revenue recovery.

This position will require constant contact with insurance company representatives, dental practices, and patients.

Responsibilities:

- Follow up on unpaid, underpaid, and denied insurance claims.
- Verify claim receipt, processing status, eligibility, and benefits.
- Research and resolve routine claim issues and basic denials.
- Review Explanation of Benefits (EOBs) and apply appropriate collection actions.
- Update patient demographics, coverage information, and account details.
- Ensure timely filing requirements are met.
- Document all account activity accurately and completely.
- Respond to office inquiries regarding claim status and collection activity.
- Maintain productivity and quality metrics.
- Manage assigned work queues and aging accounts.
- Escalate complex claim issues, payer disputes, and contractual concerns to senior team members.
- Resolve complex denials and appeals with minimal supervision.
- Conduct comprehensive patient account audits to determine reimbursement opportunities.
- Analyze payer trends and identify root causes of underpayments and denials.
- Manage aging inventory and high-dollar accounts.
- Prepare and submit formal appeals and reconsideration requests.




- Research contract discrepancies and reimbursement variances.
- Train and mentor Collections Specialist I team members.
- Assist leadership with special projects and process improvement initiatives.
- Provide payer-specific expertise to dental offices and internal teams.
- Monitor compliance with payer requirements and timely filing deadlines.
- Serve as departmental subject matter expert for payer regulations, reimbursement methodologies, and contractual interpretation.
- Resolve the most complex denial, appeal, and underpayment cases.
- Conduct root cause analysis on recurring payer issues and develop corrective action plans.
- Partner with leadership to identify workflow improvements and automation opportunities.
- Lead payer escalation activities and executive-level insurance follow-up.
- Analyze collections performance, trends, and payer behavior.
- Develop training materials, desk-level procedures, and best practices.
- Mentor and coach Insurance Collections Specialists I and II.
- Assist supervisors with quality audits, productivity monitoring, and onboarding.
- Participate in system testing, implementation projects, and process redesign initiatives.




- Act as the department lead during supervisor absences as needed.

Experience:

- Expert knowledge of dental insurance reimbursement and collections.
- Advanced understanding of CDT coding, payer processing guidelines, and claim adjudication.
- Strong leadership and mentoring capabilities.
- Exceptional analytical and reporting skills.
- Ability to influence cross-functional teams and drive process improvements.

Required Skills:

- Advanced knowledge of dental insurance plans, including PPO, HMO, Medicaid, and secondary billing.
- Solid analytical and problem-solving skills.
- Ability to identify trends and recommend corrective actions.
- Excellent organizational and time-management skills.
- Ability to work independently with minimal supervision.

Core Competencies:

- Claim Resolution: Resolves highly complex claims and denial issues to maximize reimbursement.
- Appeal Management: Serves as an expert in managing and submitting complex payer appeals.
- Independence: Handles complex collection activities with minimal supervision.
- Training & Knowledge Sharing: Regularly coaches and mentors team members on collections best practices.
- Process Improvement: Leads initiatives to improve workflows, productivity, and collection of outcomes.
- Payer Escalations: Manages high-level payer escalations and drives issue resolution.
- Reporting & Analytics: Uses advanced analytics to identify trends and support decision-making.
- Leadership Responsibility: Acts as a senior SME and mentor, providing guidance and operational leadership.

📌 Lead Insurance Collection Specialist (India)
🏢 Smile Brands India
📍 India