Licensed Dental Hygienist Reviewer

Job Summary

To support the Clinical Operations team, the full-time Licensed Dental Hygienist Reviewer will perform first-level clinical reviews of dental claims and pre-treatment estimates remotely, ensuring compliance with clinical guidelines and fostering strong relationships with dental providers.

Key responsibilities

• Review assigned dental claims and pre-treatment estimates for clinical evaluation and approval
• Evaluate radiographs, dental charting, and treatment records using evidence-based guidelines
• Refer complex cases to Dental Advisors for final determination while documenting findings accurately

Required qualifications

• 5+ years of clinical experience as a dental hygienist in a private practice or comparable setting
• Active Registered Dental Hygienist (RDH) license or relevant clinical dental credential in good standing
• Strong knowledge of ADA CDT coding, dental terminology, and clinical documentation standards
• Ability to read and interpret dental radiographs and treatment records
• Proficiency with claims-processing systems and electronic health/dental records