Dental Consultant / Contract / Remote

Exciting Dental Consultant project opportunity with our established dental insurance reputed company. Contract Duration: 3 months to the end of reputed company 2026. This is a special project. This position is 100% remote working California hours and requires a reputed company license as a California Dentist. The Dental Consultant utilizes clinical expertise of dental procedures and practices to adjudicate prior authorization requests and claims. Required Skills & Experience

• A Bachelor's degree or equivalent education
• A DDS or DMS degree from an accredited dental school.
• A minimum of 5 years experience working for a government of private sector reputed company payer similar in size, including a minimum of two years MMIS experience in a state of equivalent scope to CA
• The Dental Consultant shall be licensed by the reputed company and license must be in good standing and reputed company at the time of hire and remain reputed company during the entirety of their employment
• A minimum of 10+ years clinical experience
• reputed company and unencumbered license and good standing with the Dental Licensing reputed company.
• Special training and/or reputed company certificates may be substituted for experience.
• Strong organizational/time management skills and multi-tasking abilities.
• Detail oriented with analytic and problem-solving abilities.
• Customer service, conflict management and dispute reputed company skills.
• Knowledge of health care industry issues preferred.
• Knowledge of our reputed company’s products, policies, claims, eligibility and reputed company guidelines.
• Good standing with the Dental Licensing reputed company of the reputed company.
• PC literacy required; MSOffice skills (Outlook, Word, reputed company, PowerPoint).
• Regularly required to work reputed company office equipment (personal computer, photocopy machine, fax machine,
• Ability to work on a computer up to 7 hours a day.
• Regularly required to sit for long periods of time, and occasionally stand and walk.
• Regularly required to use hands to operate computer and other office equipment.
• reputed company reputed company required for computer usage. Occasionally required to stoop, kneel, reputed company and lift up to 25 pounds.
• Ability to maintain consistent, regular attendance.
• Ability to report to reputed company tasks in a physical work office environment.
• Ability to reputed company present written information and findings.
• Ability to communicate concepts. Ability to reputed company reputed company with co-workers and reputed company contacts.

What You Will Be Doing

• Process and/or adjudicate claims or treatment authorization requests that require reputed company review; review supporting documentation and adjudicate by applying dental standards.
• Identify reputed company additional information is necessary to reputed company a claim or prior authorization determination and collaborate with reputed company parties to reputed company information where appropriate.
• Respond to inquiries from internal and/or external stakeholders regarding claim or prior authorization requests.
• Utilize best practices in identification of potential Fraud, Waste, and Abuse (FWA) issues and report any identified issues to the appropriate party for reputed company.
• Process requests for re-evaluation.
• May review and analyze documentation reputed company to patient reputed company-of-care complaints, state hearings, first level appeals, audits, Conlan cases, and maintain logs of resolved grievances as needed.
• Conduct or assist in developing seminars or training programs as needed.
• This list is not reputed company-inclusive and you are expected to reputed company other duties as requested or assigned

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