Dental Claims Hygienist

Bring your dental expertise to a role where clinical knowledge meets claims decision-making. We’re looking for a knowledgeable and detail-oriented Dental Claims Hygienist to review and interpret dental information related to group dental claims, pre-determinations, appeals, complaints, and grievances. In this role, you’ll apply your understanding of dental procedures, policies, and standards of practice to evaluate claims and determine the appropriate outcome. You’ll review documentation for accuracy and completeness, identify inconsistencies or potential fraud, and make informed recommendations based on contractual plan provisions. Apply today! Our next training class starts on Friday, October 9th. Training will be 7:30-4:00pm CST, for 6 weeks. WHAT WE CAN OFFER YOU: Base Salary: $65,000, plus annual bonus opportunity. 401(k) plan with a 2% company contribution and 6% company match. Work-life balance with vacation, personal time and paid holidays. See our benefits and perks page for details. Applicants for this position must not now, nor at any point in the future, require sponsorship for employment. WHAT YOU'LL DO: Clinical Claims Review: Evaluates dental claims, pre-determinations, appeals, complaints, and grievances using clinical guidelines, contract provisions, dental procedures, and coding requirements to support accurate decisions. Claims Resolution & Documentation: Thoroughly analyzes claim information, documents dental opinions, coordinates independent reviews, and ensures timely and complete resolution of claims and appeals. Fraud & Compliance: Identifies potential fraudulent activity through comprehensive claim and provider reviews, uses data reporting tools to detect risks, and escalates findings for further investigation. Collaboration & Communication: Partners with dental vendors, consultants, management, legal teams, and internal stakeholders, including supporting depositions, trials, and peer-review processes when needed. Training & Continuous Improvement: Uses dental expertise to educate claims associates, facilitate training and presentations, promote quality and compliance, and identify cost-effective process efficiencies. WHAT YOU’LL BRING: Professional Credentials: Active Dental Hygiene License with 5–7 years of relevant direct patient-care experience; maintains licensure and certifications through ongoing education. Dental & Insurance Expertise: Strong knowledge of dental evaluation, claims procedures, treatment cases, billing, terminology, policy provisions, insurance plans, and applicable regulations such as ERISA. Analytical Decision-Making: Demonstrates sound judgment, critical thinking, initiative, creativity, problem-solving, and confidence in making difficult decisions. Communication & Collaboration: Excellent interpersonal, written, and verbal communication skills with the ability to collaborate, teach, organize, and work effectively with others. Adaptability & Technology: Able to work autonomously under pressure, meet deadlines, navigate multiple business systems, adapt to change, and travel up to 25%. You promote a collaborative culture, value different ideas and opinions, and listen courageously, remaining curious in all that you do. Able to work remotely with access to a high-speed internet connection and located in the United States or Puerto Rico. We value unique experience, skills, and passion for innovation. If your experience aligns with the listed requirements, please apply! If you have questions about your application or the hiring process , email our Talent Acquisition area at [email protected] . Please allow at least one week from time of applying if you are checking on the status. Stay Safe from Job Scams Mutual of Omaha only accepts applications from mutualofomaha.com/careers . Legitimate communications will come from '@mutualofomaha.com.' We never request sensitive information or extend job offers without conducting interviews. For more details, check our Hiring FAQs . Stay alert for scams and apply securely! Hiring Policies and Legal Notices