Dental Consultant / Contract / Remote

About the role

This is a special project position for an exciting Dental Consultant role with an established dental insurance client. The contract duration is 3 months until the end of October 2026. The position is 100% remote, working California hours, and requires a current license as a California Dentist.

Responsibilities

• Utilizes clinical expertise of dental procedures and practices to adjudicate prior authorization requests and claims.
• Identify when additional information is necessary to make a claim or prior authorization determination and collaborate with internal and external parties to gather information where appropriate.
• Respond to inquiries from internal and/or external stakeholders regarding claim or prior authorization requests.
• Utilize best practices in identification of potential Fraud, Waste, and Abuse (FWA) issues and report any identified issues to the appropriate party for resolution.
• Process requests for re-evaluation.
• May review and analyze documentation related to patient quality-of-care complaints, state hearings, first level appeals, audits, Conlan cases, and maintain logs of resolved grievances as needed.
• Conduct or assist in developing seminars or training programs as needed.

Requirements

• A Bachelor's degree or equivalent education.
• A DDS or DMS degree from an accredited dental school.
• A minimum of 5 years experience working for a government or private sector healthcare payer, including a minimum of two years MMIS experience in a state of equivalent scope to CA.
• A minimum of 10+ years clinical experience.
• An active and unencumbered license and good standing with the Dental Licensing Board of the State of California.
• Strong organizational/time management skills and multi-tasking abilities.
• Detail oriented with analytic and problem-solving abilities.
• Customer service, conflict management, and dispute resolution skills.
• Knowledge of health care industry issues preferred.
• Knowledge of the client’s products, policies, claims, eligibility, and underwriting guidelines.
• PC literacy required; MS Office skills (Outlook, Word, Excel, PowerPoint).

SkillsKnowledge of health care industry issues preferred.

Knowledge of the client’s products, policies, claims, eligibility, and underwriting guidelines.

PC literacy required; MS Office skills (Outlook, Word, Excel, PowerPoint).