The Dental Clinical Reviewer is responsible for reviewing dental and oral surgery requests and clinical notes to determine if the claims are eligible for payment based on reasonableness of treatment as it relates to The Health Plan's contract provisions, dental plan benefits and claims administration policies, and dental standards of practice.
At least three years of managed care experience (with an understanding of appropriate utilization of services and the policies that support these services) preferred.
Desired, but not required:
Job Type: Part-time
Currently, The Health Plan is conducting phone or Skype interviews.
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