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Dental Benefit Examiner

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Blue Cross Blue Shield of Arizona

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Location:
United States , Phoenix

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Contract Type:
Not provided

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Salary:

Not provided

Job Description:

The Dental Benefit Examiner is responsible for data entry, review, and processing of dental prior authorization, retro-review requests, and referral requests.

Job Responsibility:

  • Processes prior authorization requests and retro-reviews indicating final consultant or department determination, and securely inform providers of decisions
  • Processes referral requests in accordance with clinical review criteria
  • Answers incoming provider calls to research, and bring resolution to provider questions, problems, or concerns
  • Verifies eligibility for coverage of dental benefits to avoid duplication of services and duplication of billing
  • Works in conjunction with the dental director by recommending consultant review when appropriate medical-necessity authorization is necessary
  • Communicate with providers on member-related issues

Requirements:

  • Two years of dental administrative/clinical experience required
  • High school degree or equivalent GED required
  • Dental administrative/clinical experience
  • Ability to read and interpret dental x-rays
  • Computer experience in Microsoft Excel, Word, Outlook
  • Knowledge of Medicaid and Medicare regulations and guidelines
  • Knowledge of dental coding and terminology
  • Knowledge of HIPPA regulations
  • Effective time management skills
  • Effective interpersonal and communication skills
  • Ability to prioritize work tasks to adhere to deadlines and identified time frames
  • Ability to work cooperatively, positively, and collaboratively in a team environment

Nice to have:

  • Minimum one year of experience in a managed care organization or related healthcare delivery system
  • Dental assisting certification preferred

Additional Information:

Job Posted:
April 16, 2026

Employment Type:
Fulltime
Work Type:
Remote work
Job Link Share:

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