Momentum Metropolitan Holdings Limited
Role Purpose
The purpose of the Dental Advisor role is to provide expert clinical and technical dental input across Health Risk Management Strategy and operations, ensuring high-quality, evidence-based decision-making on complex, escalated, and exceptional dental cases.
The Dental Advisor supports the Head of Dental Strategy with clinical input into dental system design, benefit innovation, and the ongoing optimisation of dental risk management frameworks.
The role serves as the dental clinical Subject Matter Expert (SME), supporting operational teams through specialist case input, dental coding expertise, and fraud, waste and abuse (FWA) investigations.
In addition, the Dental Advisor provides independent clinical oversight across dental claims, pre-authorisations, benefit interpretation, and provider behaviour, ensuring clinical appropriateness, regulatory compliance (including CMS and PMB requirements), member fairness, and scheme sustainability.
The role acts as a key clinical governance safeguard between policy intent, operational execution, and system rule application.
Requirements
Matric.
BChD / BDS or equivalent dental qualification.
Registered with the HPCSA as a Dental Practitioner.
Dental advisory experience within a managed care or medical scheme environment.
Strong working knowledge of dental coding (mandatory).
Experience providing clinical input on complex, escalated, or exception dental cases.
Experience in fraud, waste and abuse investigation and advisory support (advantageous).
Duties & Responsibilities
Clinical Governance and Compliance:
Apply CMS regulations, PMB rules, and scheme policies to dental cases and benefit interpretation.
Ensure evidence-based, defensible, and audit-ready clinical decision-making.
Support responses to CMS, SADA, DENTASA, internal audit, and regulatory queries where dental clinical input is required.x
Claims and Pre-Authorisation Oversight:
Clinically review high-cost, in-hospital, PMB, and escalated dental claims.
Provide clinical recommendations on approvals, rejections, and appeals.
Guide Operations on complex clinical escalations and interpretation of dental clinical policy.
Benefit Design and Product Support:
Provide clinical input into dental benefit design, annual reviews, and benefit optimisation initiatives.
Assess clinical relevance and risk impact of new dental and laboratory codes.
Advise on exclusions, limits, frequencies, and clinical eligibility criteria.
Provider and Network Advisory:
Identify abnormal or high-risk provider claiming patterns.
Support provider education, remediation, and fraud, waste and abuse investigations.
Provide clinical input into network rules and provider credentialing criteria.
System and Rule Enablement:
Translate dental clinical policy into system adjudication logic.
Validate clinical rules including tooth numbering, age limits, procedure combinations, and ICD-10 alignment.
Participate in UAT and provide clinical sign-off for dental-related system and rule changes.
Competencies
Business Acumen.
Client/ Stakeholder Commitment.
Drive for Results.
Impact and Influence.
Collaboration.
Closing Date
2026/03/12
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