Reviewing Dentist

The Reviewing Dentist for appeal claims is a licensed dental professional who completes clinical reviews of dental claim appeals to determine benefit assignment in accordance with Guardian clinical guideline criteria. The role focuses on benefit determination (not treatment recommendations) and supports consistent, fair application of dental policy. Responsibilities also include assigned peer-to-peer and provider outreach calls. This position reports to the Assistant Dental Director.

Schedule: 24 hours/week.

Key Responsibilities

Clinical Appeals Review

• Independently review appealed claims and clinical documentation.

• Apply clinical criteria, dental policy, and benchmarks to ensure consistent, defensible decisions.

• Document clear clinical rationale to support decisions, compliance, and audits.

• Escalate cases as needed to the Dental Director/leadership.

• Communicate openly, demonstrate self-awareness, and incorporate feedback.

• Participate in monthly updates, quarterly IRR exercises, and required calibration sessions.

• Support implementation of new review policies/criteria as directed.

• Meet production, accuracy, and performance standards.

Peer-to-Peer Communications

• Conduct peer-to-peer communications with treating providers (phone and/or written) to explain documentation-based clinical determinations.

• Communicate decisions clearly and professionally, with a focus on transparency and provider understanding.

• Support positive provider relationships through thoughtful, clinically grounded communication.

• Conduct provider outreach calls to request missing documentation and/or communicate review outcomes.

Vendor & Cross-Functional Collaboration

• Partner, as needed, with an external clinical review vendor to align documentation standards, clinical interpretation, and review quality.

• Collaborate with Dental Claims, Network, Product, Compliance, and Quality partners to support clinical operations.

• Provide clinical input on appeal trends, documentation gaps, and process improvement opportunities.

Qualifications

• DDS or DMD from an accredited dental school.

• Active, unrestricted dental license in at least one U.S. state.

• Minimum 5+ years of clinical dental experience.

• Prior experience in dental claims clinical review.

• Utilization review, clinical appeals, managed care, or similar experience preferred.

• Ability to render sound clinical decisions based on submitted documentation, clinical criteria, and industry standards.

• Strong written and verbal communication skills, including peer-to-peer communications via phone and email.

Salary Range:

$103,450.00 - $169,960.00

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.

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.

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. Explore our company benefits at . 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.

Accommodations

Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the individual's known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. 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 [email protected]. Please note: this resource is for accommodation requests only. For all other inquires related to your application and careers at Guardian, refer to the Guardian Careers site.

Visa Sponsorship

Guardian is not currently or in the foreseeable future sponsoring employment visas. In order to be a successful applicant. you must be legally authorized to work in the United States, without the need for employer sponsorship.

Current Guardian Colleagues: Please apply through the internal Jobs Hub in Workday.

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 guardianlife.com .

Visa Sponsorship:

Guardian Life is not currently or in the foreseeable future sponsoring employment visas. In order to be a successful applicant, you must be legally authorized to work in the United States, without the need for employer sponsorship.