Market leading healthcare organization looking for Clinical Review Support Specialists to join our team in a hybrid role! Great opportunity, please call us today! Ideally looking for candidates within 50 miles of Milwaukee, WI as candidate will need to go onsite 1-2 times per month. JOB SUMMARY:The Clinical Review Specialist I provides timely and accurate review and authorization of dental services based on eligibility and contract requirements. PRIMARY JOB RESPONSIBILITIES:Successful completion of the Clinical Review Specialist training programRead, interpret and analyze x-rays and requests for major dental services based on medical necessity, client coverage, provider participation and member eligibilityResolve claim and prior authorization that require UM ReviewConsistently meet productivity requirementsMaintain audit score of 95% or greaterPass the IRR quarterlyCommunicate and work effectively with co-workers and Leads to coordinate workload to ensure all work is completed dailyKnowledge of reference materials and documentation that contain market intelRespond to follow-upsProvide customer service via the telephone to providers regarding clinical issues Requirements:High School Diploma or equivalent1 year dental hygienist experienceAbility to read and interpret x-rays, dental models, photos, and/or patient chartsPreferred: Previous Dental Insurance Experience a plusGood interpersonal skillsAbility to work independentlyExcellent communication skillsEfficient PC skills (Word, Excel, Outlook)Ability to prioritize and organize multiple tasksAbility to remain organized with multiple interruptionsKnowledge of telephone systemsAbility to work in excess of 40 hours in a weekRequired to attend additional training as required/deemed necessary Experience:Dental hygienist: 1 year (Required)interpreting x-rays, dental models, photos, patient charts: 1 year (Required)dental insurance: 1 year (Preferred) Work Location: Remote Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com. Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility). This posting is open for thirty (30) days. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.