Professional Dental Claim Specialist II

The Dental Claims Specialist reviews claims based on medical necessity, in accordance with client contracts, evaluate appeals, counsel providers, identify providers with aberrant utilization patterns, provide clinical support for provider outreach, and act as a clinical SME (or liaison) for internal entities.

Review dental claims as assigned by the company.
• Authorize or deny claims based on medical necessity and eligibility, in accordance to contract language after clinical review enters claim status into the system.
• Evaluate appeals and determine if proper documentation has been obtained to deny or approve claim. Make further recommendations, request additional information, review charts, and make revised or reiterate claim decision.
• Review initial claims, appealed reviews, and pre-authorizations.
• Attend and participate in monthly consultant meetings, where claim review, technology, processes, innovations, specific procedure review of both old and new procedure codes, and any other pertinent business associated with the review of claims will be discussed.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties, and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and the requirements of the job change.

• Graduate of an ADA accredited dental school (DDS or DMD).
• Current and maintained unrestricted dental/dentist licensure in a U.S. state. If a specialist, board certification is preferred.
• 10 years of clinical dental experience preferred.
• Knowledge of general dentistry.
• Efficient computer skills.
• 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.

Job Demands:

• This is a part-time role with flexible hours approximately 15-20 per week (early morning hours preferred).
• This role will work from home within the continental United States.
• Access to high-speed internet is required.
• After hours and/or weekend work may be required where necessary for major deliverables /deadlines.
• Must be able to sit and use a computer keyboard for extended periods of time.
• Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.

Mental Requirements:

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

• Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
• No adverse environmental conditions expected.

Base compensation ranges from $34.00 to $45.75 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 5/21/2026

Applications are assessed on a rolling basis. We anticipate that the application window will close on 7/21/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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