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Guardian Life Dental Claims Specialist IV in Helena, Montana

As a Dental Claims Specialist IV, you are responsible for maintaining a regular clinical review schedule of a minimum of 32 hours per week (required regular schedule of 4 x 8-hour days with hours between 6am-7pm PST Monday-Friday) or a minimum of 24 hour per week (required regular schedule of 3x 8-hour days with hours between 6am-7pm PST Monday-Friday) , with expected 24-48-hour turnaround time for items available for clinical review and peer to peer phone calls.

This position reports to the Assistant Dental Director

You Will:

  • Provide clinical review of predeterminations, claims, and/or appeals by accurately reviewing radiographs and/or other diagnostic information to determine claim decision in accordance with Guardian clinical guidelines. May also include other responsibilities, such as completion of assigned Peer to Peer calls, participation in panel review of clinical determinations, completion of Clinical Grievance reviews, and participation in credentialing meetings

  • Be responsible for maintaining quality work ensuring that review determinations are sound and supported by the diagnostic materials submitted and in accordance with Guardian Clinical Policies. Success in this role will be measured based on a combination of production and quality metrics

  • Support implementation of any new clinical review policy/criteria recommended by Dental Officer, Dental Standards & Quality Management and maintain awareness of continuous updates as pertaining to clinical review

Functional Skills

  • In-depth knowledge of CDT codes, procedures, and dental insurance concepts

  • Strong knowledge of Guardian dental clinical policies and guidelines

  • Ability to manage multiple workloads with multiple deliverables

  • Adapts to changing business priorities and environments

Leadership Behaviors:

  • Demonstrates the courage to make difficult decisions and have candid conversations

  • Sets and achieves high performance standards

  • Continuously strives to provide superior/professional customer service

  • Expresses oneself in an open and honest manner

  • Demonstrates self-awareness and embraces feedback

You Have:

  • Degree from ADA approved dental school

  • Minimum 10 years clinical practice

  • Dental License in a minimum of one state (Licensure in multiple states, especially NJ, TX, CA, preferred), Periodontist preferred

  • Strong communication skills

  • Strong computer skills with proficiency in Windows-based programs; including, but not limited to Outlook, Teams, Internet Explorer, and Chrome

Our Promise

At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

Salary Range

$68,890.00 - $127,930.00

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.

Inspire Well-Being

As part of Guardian’s Purpose – to inspire well-being – we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues.

Health Care

  • Choice of [high deductible/copay] medical plans* with prescription drugs, including coverage for fertility and transgender inclusive benefits

  • Dental plan

  • Vision plan

  • Health care accounts – flexible spending, health reimbursement, and health savings accounts

  • Critical illness insurance

Life and Disability Insurance

  • Company-paid Life and Disability insurance plus voluntary supplemental coverage

  • Accident insurance

Retirement and Financial

  • 401(k) retirement plan with a company match, plus an annual age/service-based Company contribution and an annual profit-sharing contribution, if applicable

  • Complimentary 1:1 financial guidance with a licensed Fidelity representative

Time Off and Remote Work

  • Flexible work arrangements (part in-person/part remote)

  • Unlimited paid time off for most roles plus time off for volunteering, jury duty, voting, and bereavement

  • Personal holidays for colleagues to use in recognition of religious, cultural, or civic days

  • Paid parental leave and paid family and medical leave policies

Emotional Well-being and Work-Life

  • Emotional well-being, mental health, and work/life resources powered by Spring Health

  • Wellness programs, including fitness program and equipment reimbursement

  • Child, adult, and elder back-up care support through Bright Horizons

  • Adoption assistance

  • College planning

  • Tuition reimbursement

  • Student loan assistance

  • Commuter benefits in select metropolitan areas

Justice, Equity, Diversity & Inclusion (J.E.D.I.)

  • Employee Resource Groups that advocate for inclusion and diversity

  • J.E.D.I. certification and training programs

  • Matching gifts/volunteering

Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits.

Equal Employment Opportunity

Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.

Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact .

Every day, Guardian helps our 29 million customers realize their dreams through a range of insurance and financial products and services. Our Purpose, to inspire well-being, guides our dedication to the colleagues, consumers, and communities we serve. We know that people count, and we go above and beyond to prepare them for the life they want to live, focusing on their overall well-being — mind, body, and wallet. As one of the largest mutual insurance companies, we put our customers first. Behind every bright future is a GuardianTM. Learn more about Guardian at .