LIBERTY DENTAL PLAN CORPORATION

Provide clinical leadership by reviewing dental claims, prior authorizations, and appeals to ensure medical necessity and regulatory compliance. Collaborate with providers through peer-to-peer consultations and partner with internal teams to improve care quality and health outcomes.

Perform clinical reviews of dental claims, prior authorizations, and referrals to ensure medical necessity and regulatory compliance. Support quality management initiatives, peer-to-peer consultations, and utilization analyses across various lines of business.

The role involves performing internal audits to ensure organizational compliance. It focuses on evaluating internal controls and operational efficiency.

Analyze market performance data to identify trends and opportunities while supporting operational initiatives across claims, provider, and member processes. Collaborate with cross-functional teams to resolve issues, improve workflows, and develop reports for leadership decision-making.