Many dentists tend to gravitate toward consulting positions when they encounter a career altering illness or injury.   Among the many options that are available to licensed dentists are positions with the numerous dental insurance companies scattered throughout the United States.   These positions are often not publicized and therefore detailed knowledge on how they work is often quite limited.

In order to give potential applicants a fair idea on what to expect, we are presenting the facts about the industry to you to aid in your search for a valued position.   Maintaining relevance and value are often very frightening concerns that a dentist faces when the possibility of curtailing clinical practice is near.   Of course, moving on to fields entirely unrelated to dentistry and healthcare is an option, but we have found that most dentists desire to continue to use the knowledge they have so painstakingly acquired over the years to benefit not only themselves but others.

Many will look to the field of insurance claim examination/adjusting as a supplement to their clinical practice and this is often pursued to give a variety of experiences to one’s career efforts.   It really doesn’t matter, what you’re underlying motivation is dependent on.   What your primary concern should be; is being content in your decision and happy with the role you play in the industry.   Of course, financial considerations will be a factor in your decision as well as time available, and your overall physical capability.

In reviewing your options, understand there is two tiers of available positions within the dental insurance claim industry.  The full-time, management positions for each company/corporation are limited and often filled by later transfers and internal promotion from the lower tier examiner position.  Management positions are highly desired and may require advanced education (MBA) and experience depending on the company involved.   These positions are salaried at the junior executive level in the 6 figure range and include a corresponding benefits package.   Each company will have executive in charge of the dental claims department, each reporting to the COO/CEO of the corporation and it’s board.   Some company have as few as one, and a few have several regional dental managers at this level.

The vast majority of claims adjusters/examiners are in the first tier. These examiners will very likely be required to maintain an active dental license and may need to have a current license for each state they review claims for.   Years ago, these examiners were also employees that reviewed paper charts by hand and had longer careers as tenured employees of dental insurance corporation.   These position have been quickly weeded out by the progress of technology and paperless charting. The internet and wireless claims submission have essentially allowed the corporate financial officers to relegate claims adjusting to a on-line position.

When a claim is submitted, it first must be reviewed by several lay claims adjusters to determine accuracy and only then can a claim be approved. These lay claims adjusters check codes, patient identification, appropriate fees, and documentation. Valid licenses are verified as well as membership validation in that particular plan/company.

Once a claim is approved from a documentation standpoint it will go through another layer of scrutiny to ensure the procedure matches the documentation forwarded. Although this may appear arbitrary, this is required in a profit driven industry.   Non-dental claims examiners become very skilled in identifying fraudulent and questionable claims that have already passed the first documentation exam.

From here, suspect claims must be forward to a trained dentist for evaluation.   There are essentially two types of claims examined.   The first as those identified as questionable and the second are routine samples of approved claims as a quality control protocol.   The days of driving down to the insurance company headquarters and reviewing paper claims by hand are over.   Claims examiners now almost exclusively review claims from home.   They are essentially independent consultants and save the insurance companies considerable time and money.   They are often not employees and are paid by the claim.  Insurance companies process thousands of claims each day. Adjusters will sign up for a specific number of claims by date, and then forward the results of each review electronically.   Your primary mission will be to fight fraud and abuse of the claims process.

The big question is………how much can I expect to make doing these reviews/exams?   The answer is as much as you want.   It depends on how many hours you want to work each week and your skills in reviewing the claims. You will have standards to maintain, and your superiors will undoubtedly remove weaker adjusters who are not timely or accurate.   Claims are paid individually at the rate of 1-2 dollars a claim.   Likely closer to 1 dollar than 2.  Consultant adjusters will often process 50 or more claims an hour once they become very proficient.  This obviously entails many hours reviewing radiographs and charts on your computer.  The advantage is that you don’t have to leave home or see patients in an office.

A determined review of online adjuster positions is advantageous, but be prepared for limited solid opportunities by using this method.  Some may require you to relocate near a regional headquarters.   Some may require specific dental licenses for each state.  These requirements are always changing and keeping a list of positions is recommended.  Another way to find an opening is by contacting each individual insurance company. Getting through the redtape and human resources staff is hard, but this is often the best way to find open positions.   Being persistent and calling back quarterly is another strategy.   Do not overlook contacting regional/state headquarters as well as national headquarters.  There are numerous companies involved in detail insurance and maintaining a master list is advisable.   We will publish a list in future posts.

So now sit back and look at your alternatives. Becoming a claims adjuster is not the sole opportunity open to you as a dentist.   Don’t overlook education, and becoming a teacher at a hygiene school, high school, or dental school are rewarding encore careers.   You should first concentrate on your recovery and rehabilitation.   Focus on the immediate problems and understand your long-term health is tied to your sincere efforts to get better before you move on to any new fields.   See our posting regarding the ten steps to survive disabling injuries and illness.    TEN STEPS TO SURVIVE DISABILITY    As always we will be there to help in your search for relevance and your fight for recovery.