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The Dental Consultant (DC) is responsible for reviewing dental claims and predetermination treatment plans involving dental services to determine reasonableness of treatment as it relates to plan contract provisions, dental plan benefits and claims administration policies, and dental standards of practice.
The Consultant may review radiographic images, chart notes, narratives, periodontal charting, and other diagnostic tools to determine if there is sufficient clinical documentation to warrant treatment.
The consultant will be responsible to review appeal requests.
The consultant will help to identify trends, educational needs and corrective actions related to the structure and delivery of care by health care professionals.
The consultant is responsible to provide timely responses, and effectively communicate clinical opinion of reviews.
The consultant must be able to work directly with Dental Claim Review staff, Medical Directors, Dental Directors, Client Service, and Health Care Professionals.
Must maintain an active dental license to practice dentistry in one of the US States (Required).
The individual must have experience in private practice outside of academia for minimum of five (5) years (Required).
Thorough knowledge of oral health care and experience in the practice of Dentistry (Required).
Experience with professional claim (utilization) review is highly recommended (Required).
Knowledge of the community standards of oral health care delivery and dental care benefit administration is essential.
Command of dental terminology, clinical procedures, and benefit language.
Excellent oral and written communication skills are required.
Skilled in the use of Microsoft Word, Excel, PowerPoint, and Outlook.
Capable of quickly learning and mastering the intricacies of a variety of IT systems
Excellent analytical, quantitative, and problem solving skills
Works well independently and as a contributing member of a team
Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status.
If you require an accommodation based on your physical or mental disability please email: SeeYourself@cigna.com. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.