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Dental Consultant at Delta Dental of California

Posted in Other 30+ days ago.

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Type: Full Time
Location: Alpharetta, Georgia

Job Description:

If you think this sounds like you, let s chat. Delta Dental cares about its employees and treats them well. We would love to tell you more!

If you think this sounds like you, let s chat. We would love to tell you more!

As the first company to specialize in dental insurance, we are passionate about oral health and its importance to future generations. Our core purpose is the advancement of oral health care to our customers, partners and consumers through dental insurance programs and philanthropic efforts.

We are part of the Delta Dental Plans Association, a network of companies that provides dental coverage to 74 million people in the U.S. Delta Dental of California, Delta Dental of New York, Inc., Delta Dental of Pennsylvania and Delta Dental Insurance Company, together with our affiliate companies, form one of the nation s largest dental benefits delivery systems, covering 33 million enrollees. All of our companies are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies throughout the country.

Delta Dental provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Delta Dental complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Delta Dental is looking for a solutions-oriented Dental Consultant who will be responsible for the review and final adjudication of claims and re-evaluation requests that require professional review.


How you will make an impact:

* Process claims and re-evaluate requests.

* Identify the prognosis of submitted services and approve/deny based on standard guidelines.

* Return provider s calls to discuss denials, policies and contractual limitations.

* Review and analyze documentation related to patient complaints.

* Prepare draft responses to internal staff pertaining to enrollee and provider grievances and appeals.

* Assist Managing Dental Consultants and Legal department in arbitration cases.

* Request refunds from providers.

What we look for:

* A DDS or DMS degree from an accredited dental school.

* A minimum of 10+ years of private practice dentistry.

* 2 or more years of training, processing and policy experience.

* Active and unencumbered license.

* Good standing with the Dental Licensing Board of the appropriate state.

* Detail oriented with analytic and problem-solving abilities.

* Customer service, conflict management and dispute resolution skills.

* Ability to clearly present written information and findings.

* Knowledge of health care industry issues.

* Some knowledge of Delta Dental products, policies, claims, eligibility and underwriting guidelines are a plus.

* Standard computer and software literacy, and ability work to work on a computer 8 hours a day.

* Ability to stoop, kneel, climb, and lift up to 25 pounds as occasionally needed.

Benefits and perks:

* 12 days starting vacation plus 12 holidays

* 100% paid for medical option, dental, and vision

* Onsite gym and/or gym discount and fitness incentive

* Flexible work arrangements

* Culture of learning: substantial tuition reimbursement to improve your skills

* Career growth: we love promoting from within

* Strong commitment to work/life balance

* Technology allowance

* Social responsibility and volunteer opportunities