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Job Details

UnitedHealth Group

Senior Clinical Quality Analyst - Dental - PST - Telecommute (16401127)




Full Time


Cypress, California, United States

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

This position will analyze dental claims, radiographs, patient histories and other records to ensure consistent application of and compliance with dental benefit policies and guidelines.

If you are located in Pacific Standard time zone - CA, WA, OR or AZ, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Reviews and analyzes dental claims, member history, radiographs and other supporting documents
  • Makes independent decisions regarding benefit eligibility according to established guidelines, including exceptions to policy as warranted
  • Reconsiders previously rendered benefit determinations upon request by provider or member
  • Identifies and reports on atypical patterns of care
  • Acts as a liaison between consultants, providers members and operational departments to resolve claims payment issues and complex cases
  • Provides expert analysis and testimony to corporate appeals and grievances
  • Work collaboratively with all constituents to build positive business relationships
  • The Level 2 review team supports an HCQAI initiative for 2010
  • Positions in this function are responsible for direction and guidance on clinical quality improvement and management programs including accreditation
  • Conducts clinical quality audits and may also be responsible for NCQA requirements
  • Reporting and analysis of member care quality and for the development of plans and programs to support continuous quality improvement using HEDIS and other tools
  • Analyzes and investigates
  • Provides explanations and interpretations within area of expertise

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • High School Diploma
  • 3+ years knowledge of dental claims processing and claim review
  • 3+ years staff management experience
  • Experience reviewing x-rays
  • Detailed knowledge of dental procedures, coding and benefit contracts
  • PC Skills (Microsoft Word Excel and Powerpoint)

Preferred Qualifications:

  • Undergraduate degree
  • Dental Assistant Certification
  • Dental Hygienist

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.(sm)

Nevada Residents Only: The salary range for Nevada residents is $72,800 to $129,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.