Siu Claims Jobs in Riverside, CA (NOW HIRING)

LIBERTY Dental Plan is seeking a highly experienced and collaborative Senior Staff Dentist to provide clinical leadership across our Utilization Management (UM) and Utilization Review (UR) programs. This role is ideal for a dentist with experience in the dental benefits (payer) environment who is passionate about improving care quality, ensuring compliance, and driving better health outcomes.

You will play a key role in reviewing claims and prior authorizations, partnering with providers, and supporting care delivery across Commercial, Medicare Advantage, and Medicaid populations—particularly within California Medicaid (Medi-Cal) programs.

• Review dental claims, referrals, and prior authorization requests to ensure medical necessity and regulatory compliance
• Interpret dental records, radiographs, and benefit plans to make clinically sound coverage determinations
• Identify utilization trends, inappropriate services, and opportunities to improve care delivery
• Conduct retrospective reviews and influence provider behavior through engagement
• Perform secondary reviews, including grievances and appeals determinations

• Participate in Quality Improvement and Performance Management initiatives (PPM, SIU)
• Conduct focused chart audits to identify utilization and care delivery patterns
• Contribute to quality committees and regulatory reporting
• Provide clinical expertise in resolving provider and member grievances

• Conduct peer-to-peer consultations with network providers
• Promote provider education and engagement to improve documentation and care quality
• Collaborate with specialists and internal teams on complex cases

• Work closely with Analytics, Utilization Management, Claims, Provider Relations, and G&A teams
• Partner with leadership on clinical initiatives, training, and operational improvements
• Participate in state oral health initiatives and internal programs

• ~30% peer-to-peer provider calls
• ~30% clinical reviews (DCM and HCA work)
• ~25% appeals and case reviews
• ~15% supporting clinical leadership and special projects

• DDS or DMD degree
• Active, unrestricted California dental license required
• Must be in good standing and eligible for credentialing
• Minimum 6 years of experience as a practicing dentist
• Minimum 2 years of experience in utilization management, claims review, or quality initiatives
• Strong clinical judgment and ability to interpret dental radiographs and patient records

• Experience in the dental benefits or payer environment
• Familiarity with California Medicaid (Medi-Cal) programs
• Ability to obtain and maintain multi-state licensure (company-supported)
• Arizona license preferred
• Experience mentoring or training clinical peers

• Knowledge of managed care, reimbursement systems, and regulatory compliance
• Expertise in dental coding, clinical guidelines, and medical necessity criteria
• Strong communication and interpersonal skills for provider engagement
• Analytical mindset with the ability to identify trends and drive improvements
• Proficiency in Microsoft Office and ability to learn new systems

• Make a meaningful impact on oral health outcomes across diverse populations
• Work remotely while collaborating with a mission-driven, cross-functional team
• Help shape clinical quality, compliance, and best practices in the dental payer space
• Engage directly with providers and influence care delivery at scale
• Receive support for additional state licensure and professional development

• Initial recruiter screening
• 45-minute interview with Hiring Manager
• Final selection following candidate review

If you’re a clinically experienced dentist with strong judgment and payer experience—and you want to influence care at scale—we encourage you to apply and join LIBERTY Dental Plan.

Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.

Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That’s why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity.

• Competitive pay structure and savings options to help you reach your financial goals.

• Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.

• Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.

• 100% employer-paid dental coverage for employees and eligible dependents.

• Vision insurance with low-cost premiums for employee-only coverage and dependents.

• Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.

• Flexible Spending Accounts for healthcare and dependent care expenses.

• Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.

• Long-term disability coverage.

• Expansive wellness programs, including company-wide wellness challenges, and gym discounts.

• Employee Assistance Program (EAP) to support mental health and well-being.

• Generous vacation and sick leave policies, with the ability to roll over unused time.

• 10 paid company holidays.

• Tuition reimbursement for eligible educational expenses.

• Remote or hybrid work options available for various positions.

In the spirit of pay transparency, the base salary range for this position is $175,000 - $185,000 annually, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions.

Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth.

Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture. 

Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve. 

We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.

Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled.

No relocation assistance or sponsorship available at this time.