Senior Dental Benefits Specialist

Location: Remote within the United States; Kansas-remote. G.E.H.A. does not hire from U.S. territories or Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, or Maine. A dedicated home office with secure handling of member PHI/HIPAA information is required.

Salary: $63,329–$80,115 USD target hiring range; maximum salary of $89,271 USD.

Company

hirify.global is a nonprofit member association providing health and dental benefits to federal employees, retirees, military retirees, and their families.

What you will do

• Own second-level appeal documentation, assessing completeness, defensibility, benefit application, and the need for additional clinical review.
• Coordinate clinical reviews between the third-party administrator and clinical review vendor, tracking case status, rationale, outcomes, and turnaround standards.
• Review determination letters and correspondence for accuracy, completeness, and clear communication of outcomes and next steps.
• Conduct post-payment dental claims audits using plan provisions, CDT coding standards, benefit limitations, and risk-based sampling.
• Prepare audit findings that document irregularities, payment amounts, supporting rationale, scope, and disposition.
• Serve as the internal dental subject matter expert for benefit interpretation, claims adjudication, CDT coding, policy reviews, and member education content.

Requirements

• At least 5 years of experience in dental claims review, dental benefits administration, or dental appeals processing in a health plan or managed care environment.
• Direct experience with appeal documentation, clinical review coordination, or claims audits in dental insurance or managed dental care is required.
• Advanced knowledge of dental benefit administration, CDT coding, claims adjudication, coordination of benefits, billing practices, and benefit structures.
• Strong independent judgment, analytical and clinical reasoning, written communication, organization, and attention to detail.
• Associate’s or bachelor’s degree in dental hygiene, health administration, or a related clinical or health field preferred; equivalent relevant experience may substitute.
• Dental clinical training, certification, or licensure such as RDH is strongly preferred.

Nice to have

• Familiarity with FEDVIP, FEHB, or federally regulated dental benefit programs.
• Experience applying clinical appropriateness criteria or benefit provisions to appeals and clinical reviews.
• Experience preparing determination letters or audit findings for members, providers, or internal audiences.
• Experience working with a TPA or clinical review vendor as a dental subject matter resource.

Culture & Benefits

• Remote work with a non-cellular high-speed internet connection; minimum required speed is 30 Mbps download and 5 Mbps upload with latency below 80 ms.
• Hotspots, satellite, and wireless internet services are not permitted.
• Health, vision, and dental benefits are effective on the first day.
• 401(k) plan with dollar-for-dollar matching up to 4% of employee contributions plus a 6% annual company contribution.
• Paid time off, well-being programs, tuition assistance, life insurance, and short- and long-term disability coverage.