[Hiring] Dental Consultant @DELTA DENTAL OF VIRGINIA

Role Description

The Dental Consultant is responsible for participating in Utilization Management for Delta Dental of Virginia and works closely with the Professional Review, Dental Director, and Chief Dental Officer. This position is focused on claims review and will be partnered with the dental director. This position assists in developing dental policy and procedures consistent with Delta Dental’s mission to ensure a competitive position for the company.

Essential Functions

• Provide leadership and coordination of efforts between departments related to Delta Dental of Virginia.
• Claims Administration responsibility for:
  • The determination of dental necessity and appropriateness of treatment standards.
  • Assisting in the development of dental policy and staff calibration practices.
  • Providing recommendations on policy for efficient and effective benefit review processes.
  • Providing recommendations to the Professional Review staff specific to claims determinations and interpretation of dental policy.
  • Adjudicate special claims and benefit review requests in a timely manner.
  • Administer other dental-related issues impacted by Delta Dental’s policies or procedures.
  • Responsible for the timely and accurate review of claims to achieve cycle-time and accuracy standards.
  • Communicate with dental care providers regarding claim and benefit matters to resolve disputes on individual claims.
  • May perform other functions as assigned.

Qualifications

• A degree from an accredited U.S. College of Dentistry (DMD or DDS) with a current dental license or eligibility for Virginia license to practice dentistry.
• Minimum of 5 years dental practice experience; two or more years of dental consulting experience is preferred and clean malpractice history.
• Evidence of regular Continuing Education course completion.
• Administrative or management experience preferred.
• Familiarity with current dental science, utilization review techniques, data/statistical analysis, practice protocols, and ADA issues.
• Ability to analyze data and make effective decisions.
• Knowledge and understanding of healthcare insurance products, dental industry trends, and the administrative delivery of group products desirable.
• Ability to think and plan strategically for organizational success.
• Strong interpersonal and communication skills.

Physical Demands and Work Environment

• Occasionally required to walk, sit, use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk or hear.
• Use of hands is required for technological devices such as a computer, telephone, and others.
• Must occasionally lift and/or move up to 15 pounds.
• Specific vision abilities required include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
• Required to travel (sometimes long distances) to attend required meetings.
• Work is limited to the office environment with occasional trips to other office facilities or locations necessitating walking outdoors or driving.
• The noise level in the work environment is usually minimal.

Benefits

• Annual Incentive Plan opportunity available to all team members.
• Comprehensive health coverage including Medical, Dental, Vision, Pharmacy, Life, and AD&D insurances.
• 24/7 On-Demand TextCare: Fast, text-based access to board-certified medical providers.
• A robust 401(k) program with company matching and annual discretionary Profit Sharing contributions.
• Flexible hybrid/remote work options available for most roles.
• Generous paid time off programs including holidays, Paid Time Off (PTO), Volunteer Time Off (VTO), and an extra day off to celebrate your birthday.
• Employee Assistance and Health and Wellness programs, including an onsite fitness center for team members working onsite.
• Voluntary Benefits such as Critical Illness and Accident coverage, Pet Insurance, and Legal Resources.
• Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA) to support your financial wellbeing.
• Professional development, Tuition Reimbursement, and Educational Assistance programs to fuel your growth.
• A culture where your work contributes to healthier communities and more smiles every day.