Role Purpose\u00a0\u00a0 \u00a0<\/p>\n
\tThe 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.
\n\tThe 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.
\n\tThe 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.
\n\tIn 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.
\n\tThe role acts as a key clinical governance safeguard between policy intent, operational execution, and system rule application.<\/p>\n
Requirements\u00a0\u00a0 \u00a0<\/p>\n
\tMatric.
\n\tBChD \/ BDS or equivalent dental qualification.
\n\tRegistered with the HPCSA as a Dental Practitioner.
\n\tDental advisory experience within a managed care or medical scheme environment.
\n\tStrong working knowledge of dental coding (mandatory).
\n\tExperience providing clinical input on complex, escalated, or exception dental cases.
\n\tExperience in fraud, waste and abuse investigation and advisory support (advantageous).<\/p>\n
Duties & Responsibilities\u00a0\u00a0 \u00a0<\/p>\n
Clinical Governance and Compliance:<\/p>\n
\tApply CMS regulations, PMB rules, and scheme policies to dental cases and benefit interpretation.
\n\tEnsure evidence-based, defensible, and audit-ready clinical decision-making.
\n\tSupport responses to CMS, SADA, DENTASA, internal audit, and regulatory queries where dental clinical input is required.x
\n\tClaims and Pre-Authorisation Oversight:
\n\tClinically review high-cost, in-hospital, PMB, and escalated dental claims.
\n\tProvide clinical recommendations on approvals, rejections, and appeals.
\n\tGuide Operations on complex clinical escalations and interpretation of dental clinical policy.
\n\tBenefit Design and Product Support:
\n\tProvide clinical input into dental benefit design, annual reviews, and benefit optimisation initiatives.
\n\tAssess clinical relevance and risk impact of new dental and laboratory codes.
\n\tAdvise on exclusions, limits, frequencies, and clinical eligibility criteria.
\n\tProvider and Network Advisory:
\n\tIdentify abnormal or high-risk provider claiming patterns.
\n\tSupport provider education, remediation, and fraud, waste and abuse investigations.
\n\tProvide clinical input into network rules and provider credentialing criteria.
\n\tSystem and Rule Enablement:
\n\tTranslate dental clinical policy into system adjudication logic.
\n\tValidate clinical rules including tooth numbering, age limits, procedure combinations, and ICD-10 alignment.
\n\tParticipate in UAT and provide clinical sign-off for dental-related system and rule changes.<\/p>\n
Competencies\u00a0\u00a0 \u00a0<\/p>\n
\tBusiness Acumen.
\n\tClient\/ Stakeholder Commitment.
\n\tDrive for Results.
\n\tImpact and Influence.
\n\tCollaboration.<\/p>\n
Closing Date\u00a0\u00a0 \u00a0<\/p>\n
\t2026\/03\/12<\/p>\n
go to method of application \u00bb<\/p>\n
Apply via company website ( ) or<\/p>\n
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