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　　Job Summary

　　This highly technical and critical position is responsible for the clinical integrity, accuracy and consistency of Dental Network of America's (DNoA) dental claims review process. This role will be of particular importance, given DNoA's commitment to increase the number of clinical claims reviewed. The Sr Dental Consultant (equivalent to Dental Director without direct reports) will assume a critical role in the implementation and oversight of this enhanced review process. Reporting to the Executive Dental Director, they will work with all stakeholders to develop a vision for Dental Blue that is clinically sound, market leading and reflective of current scientific research and clinical practice. In addition to the review of complex claims and appeals, this individual will be a key contributor to the assessment and implementation of new clinical policy; at the detailed level of policy logic and decision-tree development. These clinical rules, driving the application of medical necessity determinations and contractual compliance, will be applicable across all corporate divisions of HCSC.

　　JOB REQUIREMENTS:

　　DDS or DMD degree.A minimum of five years of clinical practice experience.Current, unrestricted clinical license, and ability to provide updated license annually.Eligible for certification by the American Association of Dental Consultants (3 years retained, employed, or working in dental benefits industry).Excellent verbal and written presentation skills.Demonstrated ability to work in a team environment.Flexibility to accommodate changes in business priorities.Demonstrated ability to promote a culture of constant growth, learning and improvement.

　　PREFERRED JOB REQUIREMENTS:

　　3 years experience in dental insurance, including claims review experience.The ability to apply AI to claims review.Implement and report on the IRR (inter-rater reliability) process to ensure consistency and accuracy among clinical reviewers.Work with the Executive Dental Director to leverage the opportunity for medical-dental integration.Experience providing insight on network issues, dental claim policy and standards of care, dental plan coverage and utilization management.Member of AADC and/or NADP.

　　This position will be a telecommuter role, must reside within 250 miles of the reporting offices of either Lombard, IL or Richardson, TX

　　Relocation is not provided.

　　Sponsorship is not provided.

　　Applicants residing in CA, NY or FL will not be considered.

　　#LI-Telecommute

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　　HCSC Employment Statement:

　　HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.