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.

Hours: M-F 8am-5pm

Qualifications:

Must maintain an active dental license to practice dentistry in the state of employment.

The individual must have experience in private practice outside of academia for minimum of five (5) years.

Requires a thorough knowledge of oral health care and experience in the practice of Dentistry.

Experience with professional claim (utilization) review is highly preferred. 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.

Candidates located/licensed in California preferred.

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.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 79,700 - 132,800 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.