Our contact center will be closed for staff training from 1:00 p.m. (CT), Tuesday, May 31 through 5:00 p.m. (CT) Wednesday, June 1. We look forward to serving you again beginning at 8:00 a.m. (CT) on Thursday, June 2, 2022. Thank you for your patience as we work to provide you even better service in the future.

Professional Review Specialist 

A Professional Review Specialist reviews dental claims and ensures policy coverage aligns with payment policies. This includes review of clinical documentation and patient history; application of claims processing policies; and consulting with the dental consultant team.

Excellent customer service is expected with a variety of audiences, including dental offices, plan holders (members), and colleagues from other DDSD departments.

Duties and responsibilities

Professional Review

  • Screen dental claims for proper treatment descriptions/dental codes and proper submission of diagnostic materials in order to determine contractual obligation to treatment plan submitted.
  • Determine when claims require further review and benefit determination by the dental consultants. Work with dental consultants to reach a final decision.
  • Provide assistance over the phone to dental offices and patients with questions regarding claim adjudication.
  • Maintain strict confidentiality of member-protected health information.

Data Entry/Record Keeping

Meticulously document all steps in the process and resulting decisions, including those from the dental consultants, for the proper benefit determination and adjudication of the claim.

Other duties as assigned

 

Experience and qualifications

  • Dental Hygiene license and experience preferred.
  • A minimum of 3 years work experience related to dental offices required.
  • Strong knowledge of dental terminology.
  • Strong self-motivation and ability to work independently.
  • Excellent oral and written communication skills and the ability to interact with internal and external stakeholders in an effective and positive manner.

 

Compensation and benefits

Delta Dental provides an excellent compensation and benefit package including medical, dental, vision, life & disability insurance, paid vacation, sick leave, continuing education and 401k. More information about benefits and company culture is available on our Careers page.

How to apply

Applying for a job with Delta Dental of South Dakota is easy! Send us an email with your:

  • Cover letter;
  • Resume; and
  • Professional references.

Email Your Application