Dental Hygienist: Claims Review & Clinical Support

NationsBenefits, LLC; Plantation (FL); On-site; USD 55,000 - 75,000; Full time

Job summary

NationsBenefits, LLC is seeking aDental Hygienist to support claims processing and member/provider services for about 400,000 members. You will perform initial clinical screening of claims, x-rays, and narratives, and prepare summaries.

You will ensure cases are complete and well-documented for routing to Fluent clinical dental directors. The role requires an active RDH license in the United States and at least 2 years of clinical experience, with strong CDT code knowledge and familiarity with

Qualifications

• Graduate of an accredited dental hygiene program; active, unrestricted RDH license in good standing in the United States (state requirement to be confirmed).
• 2+ years of clinical practice experience required; dental insurance, claims review, or utilization review experience strongly preferred.
• Strong knowledge of CDT codes, periodontal classification, radiographic interpretation, and dental benefit concepts.

Responsibilities

• Review claims and attachments (radiographs, perio charting, narratives, intraoral photos) for completeness and consistency with plan clinical policies.
• Triage claims referred by Claims Processors, resolve clinical questions within scope, and escape cases requiring dental director review to Fluent with a concise clinical summary.
• Coordinate with Fluent on referrals, turnaround, and outcomes; track pending cases and ensure recommendations are applied correctly.
• Support appeals and grievances by preparing clinical case summaries and documentation.
• Serve as clinical resource to Claims, Customer Service, and Provider Support on CDT codes, treatment sequencing, periodontal and preventive services, and benefit application.
• Train and coach processors on clinical topics such as perio staging, radiographic documentation, and code selection.
• Help develop and maintain clinical coverage criteria, claim edits, and reference materials with Fluent and leadership.
• Contribute to quality audits and identify provider billing patterns for referral to compliance or SIU.
• Maintain confidentiality of PHI and comply with HIPAA and applicable state regulations.

Skills

RDH license

Clinical experience

Communication skills

Microsoft Office

Education

Bachelor degree in dental hygiene

Tools

Dental software

Job description

NationsBenefits, LLC is seeking aDental Hygienist to support claims processing and member/provider services for about 400,000 members. You will perform initial clinical screening of claims, x-rays, and narratives, and prepare summaries.

You will ensure cases are complete and well-documented for routing to Fluent clinical dental directors. The role requires an active RDH license in the United States and at least 2 years of clinical experience, with strong CDT code knowledge and familiarity with