Clinical Review Support Specialist

Description: • The Clinical Review Specialist provides timely and accurate review and authorization of dental services based on eligibility and contract requirements. • Successful completion of the Clinical Review Specialist training program. • Read, interpret, and evaluate x-rays, models, and requests for major dental services based on medical necessity, client coverage, provider participation and member eligibility, in accordance with contract language. • Resolve claim and prior authorization suspends that require UM Review. • Consistently meet productivity requirements. • Maintain audit score of 95% or greater. • Pass the IRR quarterly. • Communicate and work effectively with co-workers and Team Leads to coordinate workload to ensure all work is completed daily. Requirements: • High School Diploma or equivalent. • 1 year dental assisting experience. • Previous dental insurance experience a plus. • Ability to read and interpret x-rays, dental models, photos, and/or patient charts. • Good interpersonal skills. • Ability to work without supervision. • Excellent oral and written communication skills. • Efficient PC skills (Word, Excel, Outlook). • Ability to prioritize and organize multiple tasks. • Ability to remain organized with multiple interruptions. • Knowledge of telephone systems. • Ability to work in excess of 40 hours in a week. • Required to attend additional training as required/deemed necessary. Benefits: • Excellent benefits and wellness programs to support the three pillars of well-being – mental, physical and financial. • Generous vacation and sick time. • Market-leading paid family, parental and adoption leave. • Partially-paid sabbatical program. • Medical plans. • Company paid life and AD&D insurance as well as disability programs. • Retirement and Stock Purchase programs including a 401(k) plan with an employer-paid match and employer-funded retirement account. • A flexible work environment with a friendly, caring, collaborative and inclusive culture. Apply Job!