Senior Clinical Dental Consultant

20 hours ago

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Sun Life

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1865

💸 Finance

Description

• The Sr. Clinical Dental Consultant reviews claims based on medical necessity • Evaluate appeals, counsel providers, and identify providers with aberrant utilization patterns • Provide clinical aid for provider outreach and act as a clinical liaison for internal entities • Authorize or deny claims based on medical necessity and eligibility • Evaluate appeals and identify proper documentation for claim denial • Review authorization requests for anesthesia and render judgment on medical necessity • Review and render conclusions on orthodontic claims • Communicate claim review outcome to participating Dentists, plan members, and Health Plans • Facilitate and give Provider orientations • Develop knowledge of state and federal dental regulations • Provide guidance and education in the provider community

Requirements

• Graduate of an accredited Dental School (D.D.S. or D.M.D) • Orthodontic experience a plus • Maintain an unrestricted dental license • Knowledge of general dentistry • Efficient PC skills • Ability to use analytical/presentation tools such as Excel and PowerPoint • Organizational and time management skills • Ability to work with a team and independently to complete assigned tasks without supervision • Ability to make independent determinations on all types of dental claims • Excellent written and verbal communication skills • Ability to distinguish between multiple market benefits • Ability to prioritize and organize multiple tasks • Ability to remain organized with multiple interruptions • Networking and Negotiation skills required • Ability to travel as needed • Required to attend additional training as requested/deemed necessary

Benefits

• Excellent benefits and wellness programs to support the three pillars of well-being – mental, physical, and financial • Generous vacation and sick time • Market-leading paid family, parental, and adoption leave • Partially-paid sabbatical program • Medical plans • Company paid life and AD&D insurance • Disability programs • Retirement and Stock Purchase programs including 401(k) plan with employer-paid match and employer-funded retirement account • Flexible work environment with a friendly, caring, collaborative, and inclusive culture