State Licensed Dental Claims Specialist

Job Summary

To support efficient claims processing, the part-time State Licensed Dental Claims Specialist will review dental claims for medical necessity, authorize or deny claims based on eligibility, and evaluate appeals while working remotely within the continental United States.

Key responsibilities

• Review dental claims and determine authorization or denial based on medical necessity and contract compliance
• Evaluate appeals and ensure proper documentation is obtained for claim decisions
• Participate in monthly consultant meetings to discuss claims processes, technology, and procedure code reviews

Required qualifications

• Graduate of an ADA accredited dental school (DDS or DMD)
• Current and maintained unrestricted dental/dentist licensure in a U.S. state
• 10 years of clinical dental experience preferred
• Knowledge of general dentistry
• Efficient computer skills and the ability to work independently