Dental Consultant - Remote

Cigna Healthcare

63d • $79,700 - $132,800

About The Position

The Dental Consultant (DC) is responsible for reviewing dental claims and predetermination treatment plans involving dental services to determine reasonableness of treatment as it relates to plan contract provisions, dental plan benefits and claims administration policies, and dental standards of practice. The Consultant may review radiographic images, chart notes, narratives, periodontal charting, and other diagnostic tools to determine if there is sufficient clinical documentation to warrant treatment. The consultant will be responsible to review appeal requests. The consultant will help to identify trends, educational needs and corrective actions related to the structure and delivery of care by health care professionals. The consultant is responsible to provide timely responses, and effectively communicate clinical opinion of reviews. The consultant must be able to work directly with Dental Claim Review staff, Medical Directors, Dental Directors, Client Service, and Health Care Professionals. Hours: M-F 8am-5pm local time.

Requirements

• Must maintain an active dental license (DDS or DMD) to practice dentistry in the state of residence, CA preferred.
• Minimum of five (5) years experience in private practice outside of academia.
• Experience with professional claim (utilization) review is strongly preferred.
• Knowledge of community standards of oral health care delivery and dental care benefit administration.
• Thorough knowledge of oral health care and experience in the practice of Dentistry.
• Command of dental terminology, clinical procedures, and benefit language.
• Excellent oral and written communication skills.
• Skilled in the use of Microsoft Word, Excel, PowerPoint, and Outlook.
• Capable of quickly learning and mastering various IT systems.
• Excellent analytical, quantitative, and problem-solving skills.
• Ability to work independently and as a contributing member of a team.

Responsibilities

• Review dental claims and predetermination treatment plans.
• Determine reasonableness of treatment as it relates to plan contract provisions.
• Review radiographic images, chart notes, narratives, and other diagnostic tools.
• Review appeal requests.
• Identify trends, educational needs, and corrective actions related to care delivery.
• Provide timely responses and communicate clinical opinions.
• Work directly with Dental Claim Review staff, Medical Directors, Dental Directors, Client Service, and Health Care Professionals.

Benefits

• Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
• 401(k) with company match.
• Company paid life insurance.
• Tuition reimbursement.
• Minimum of 18 days of paid time off per year.
• Paid holidays.
• Eligibility to participate in an annual bonus plan.

What This Job Offers

• Job Type: Full-time
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees