Senior Dental Benefits Analyst — Remote, Appeals & Audits

GEHA Health; Topeka (KS); Hybrid; USD 63,000 - 89,000; Full time

Benefits offered by this job

Incentive plan

Health/Vision/Dental benefits

401(k) with company match

Well-being program

Paid Time Off

Personal Community Enrichment Time

Life and AD&D insurance

Short-Term & Long-Term Disability

Tuition Assistance Program

Job summary

Government Employees Health Association, Inc. (G.E.H.A) seeks a Senior Dental Benefits Specialist to oversee second-level appeal documentation, coordinate clinical reviews between the TPA and vendor, and conduct post-payment claims audits for dental programs.

The role requires a minimum of 5 years in dental claims review or related fields, with RDH or equivalent licensure strongly preferred. Hybrid work options available within the US.

Qualifications

• Requires 5+ years of experience in dental claims review, dental benefits administration, or dental appeals processing.
• RDH or equivalent certification/licensure strongly preferred.
• Dental benefit interpretation, CDT coding, and claims accuracy knowledge.
• Independently manage appeal documentation and clinical review coordination.

Responsibilities

• Own second-level appeal documentation and clinical review workflow with internal and external partners.
• Ensure documentation sufficiency and defensibility per plan provisions and CDT coding standards.
• Coordinate post-payment claims audits and identify overpayments or coding irregularities.
• Prepare audit findings reports with clear rationale and dollar impact.
• Act as dental SME for benefit interpretation and CDT coding questions.

Skills

Dental claims review

CDT coding

Analytical reasoning

Documentation ownership

Education

Associate's or Bachelor's degree in Dental Hygiene, Health Administration, or related health field

Tools

Claims review systems

Case management tools

Job description

Government Employees Health Association, Inc. (G.E.H.A) seeks a Senior Dental Benefits Specialist to oversee second-level appeal documentation, coordinate clinical reviews between the TPA and vendor, and conduct post-payment claims audits for dental programs.

The role requires a minimum of 5 years in dental claims review or related fields, with RDH or equivalent licensure strongly preferred. Hybrid work options available within the US.