Dental Advisor

Introduction

Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members.

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.

• 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).

• 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.

• 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.

• 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.

• 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.

• 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.

• Business Acumen.
• Client/ Stakeholder Commitment.
• Drive for Results.
• Impact and Influence.
• Collaboration.