Market leading insurance company looking for hybrid Dental Consultants in MA! This is work from home opportunity with local travel in MA (mileage reimbursed)! Must be a licensed DDS or DMD in MA for this role!
As a Dental Consultant, you'll serve as a clinical subject matter expert for the organization, preparing for and attending MassHealth Board of Hearing (BOH) events throughout Massachusetts. This flexible, as-needed role typically requires 3-4 working days per month, with up to 10 hearings per day. PRIMARY JOB RESPONSIBILITIES: - Attend in-person or telephonic Board of Hearing (BOH) events at various Massachusetts locations. - Prepare expert testimony from hearing packets provided for each BOH event and defend the clinical rationale of adverse benefit determinations. This includes clearly explaining the clinical criteria applied to prior- authorizations or claims denied. - Evaluate appeals and determine if proper documentation has been obtained to appropriately deny the prior- authorization or claim. - Represent professionally at all times. - Develop knowledge and understanding of state and federal dental regulations. - Adhere to business processes. JOB REQUIREMENTS: - Graduate of an accredited Dental School (D.D.S. or D.M.D). - 5 years of clinical experience preferred. - Maintain an unrestricted Massachusetts dental license. - Ability to travel to the location where these BOH events are held. - Knowledge of general dentistry. - Orthodontic experience a plus. - Efficient PC skills. - Ability to use analytical/presentation tools such as Excel and PowerPoint. - Organizational and time management skills. - Ability to work with a team and independently to complete assigned tasks without supervision. - Ability to make independent determinations on all types of dental claims. - Excellent written and verbal communication skills. Ability to distinguish market benefits on qualifying clinical criteria. - Ability to prioritize and organize multiple tasks. Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status. At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com....Position Overview We are seeking an experienced GIS Technician for an in-house position based in Morgantown, WV . This role... ...supports day-to-day geospatial production, data maintenance, and mapping needs, working closely with the GIS Applications Specialist and...
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