[Hiring] Reviewing Dentist @Guardian Life Insurance

Role Description

The Reviewing Dentist for appeal claims is a licensed dental professional who completes clinical reviews of dental claim appeals to determine benefit assignment in accordance with Guardian clinical guideline criteria. The role focuses on benefit determination (not treatment recommendations) and supports consistent, fair application of dental policy. Responsibilities also include assigned peer‑to‑peer and provider outreach calls. This position reports to the Assistant Dental Director.

Schedule: 24 hours/week.

Key Responsibilities

• Independently review appealed claims and clinical documentation.
• Apply clinical criteria, dental policy, and benchmarks to ensure consistent, defensible decisions.
• Document clear clinical rationale to support decisions, compliance, and audits.
• Escalate cases as needed to the Dental Director/leadership.
• Communicate openly, demonstrate self-awareness, and incorporate feedback.
• Participate in monthly updates, quarterly IRR exercises, and required calibration sessions.
• Support implementation of new review policies/criteria as directed.
• Meet production, accuracy, and performance standards.

Peer‑to‑Peer Communications

• Conduct peer‑to‑peer communications with treating providers (phone and/or written) to explain documentation‑based clinical determinations.
• Communicate decisions clearly and professionally, with a focus on transparency and provider understanding.
• Support positive provider relationships through thoughtful, clinically grounded communication.
• Conduct provider outreach calls to request missing documentation and/or communicate review outcomes.

Vendor & Cross‑Functional Collaboration

• Partner, as needed, with an external clinical review vendor to align documentation standards, clinical interpretation, and review quality.
• Collaborate with Dental Claims, Network, Product, Compliance, and Quality partners to support clinical operations.
• Provide clinical input on appeal trends, documentation gaps, and process improvement opportunities.

Qualifications

• DDS or DMD from an accredited dental school.
• Active, unrestricted dental license in at least one U.S. state.
• Minimum 5+ years of clinical dental experience.
• Prior experience in dental claims clinical review.
• Utilization review, clinical appeals, managed care, or similar experience preferred.
• Ability to render sound clinical decisions based on submitted documentation, clinical criteria, and industry standards.
• Strong written and verbal communication skills, including peer‑to‑peer communications via phone and email.

Requirements

• Salary Range: $103,450.00 - $169,960.00
• The salary range reflected above is a good faith estimate of base pay for the primary location of the position.
• The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate.
• In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation.

Benefits

• Support and flexibility to achieve professional and personal goals.
• Opportunities for skill-building, leadership development, and philanthropic activities.
• Contemporary, supportive, flexible, and inclusive benefits and resources.
• Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits.