1 claim professional development program intern jobs found

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 Clinical Appeals Review 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,...