[Hiring] Dental Fraud and Waste Lead @Humana

Role Description

Become a part of our caring community. The Humana Dental SIU Team has an exciting new opportunity for an experienced Dentist who loves to investigate and find solutions to complex issues in outstanding dental cases. Within this position, the Dental Fraud and Waste Lead for the Humana Dental SIU Team will:

• Complete dental clinical reviews associated with fraud, waste, and abuse cases.
• Perform peer-to-peer reviews with other dentists.
• Provide continued education on dental industry standards and trends to a team of 5 other Dental Investigators.
• Stay up to date on all dental industry standards and provide education and guidance to create new data tools to review provider outliers.
• Coordinate investigations with law enforcement authorities and assemble evidence and documentation to support successful adjudication, where appropriate.
• Conduct on-site audits of provider records ensuring appropriateness of billing practices.
• Prepare complex investigative and audit reports and advise executives to develop functional strategies for dental fraud, waste, and abuse cases.

WORK STYLE: Remote/work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week-- some flexibility might be possible, depending on business needs. Very minimal travel might be required for trainings, meetings, and/or conferences (less than 5% travel).

Qualifications

• Doctor of Dental Surgery (DDS) degree or DMD.
• A minimum of five years of experience in a clinical dentist office as a practicing dentist.
• Must hold a clear and active license to practice dentistry (in any US state).
• Must be comfortable with data analysis/report interpretation.
• Strong computer skills including MS Office desktop applications (Word, Excel, PowerPoint, Visio, Project).
• Demonstrated competency in both oral and written communication skills.
• Solid understanding of process/workflow concepts.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Requirements

• 5+ years of investigative or auditing experience of dental-related claims.
• Knowledge of Medicare regulations.
• Knowledge of Medicaid regulations.

Benefits

• Benefits starting day 1 of employment.
• Competitive 401k match.
• Generous Paid Time Off accrual.
• Tuition Reimbursement.
• Parental Leave.

Company Description

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides:

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance and many other opportunities.