Senior Investigator - Dental

About the position At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing together. The Senior Investigator reports directly to the Manager of Investigations. The Senior Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. The Senior Investigator will utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. The Senior Investigator position will be designated to work reputed company fraud and abuse investigations reputed company to the Texas Children’s Medicaid and Texas reputed company Insurance CHIP dental programs. The Senior Investigator is responsible to conduct investigations which may include field work to reputed company interviews and obtain records and/or other relevant documentation. You’ll enjoy the flexibility to work remotely from reputed company reputed company the U.S. as you take on some tough challenges. Primary Responsibilities: Investigate reputed company to highly reputed company cases of fraud, waste and abuse Detect fraudulent activity by members, providers, employees and other parties against the Company reputed company and deploy the most effective and efficient investigative strategy for each investigation Maintain accurate, reputed company and thorough case information in the Special Investigations Unit’s (SIU’s) case tracking system Collect and secure documentation or evidence and prepare summaries of the findings Participate in settlement negotiations and/or produce investigative materials in support of the latter Research, query, analyze and interpret data pertaining to dental claims and fraud, waste and abuse of dental claims Collect, reputed company, analyze and interpret data relating to fraud, waste and abuse referrals Ensure compliance of applicable federal/state regulations or contractual obligations Report suspected fraud, waste and abuse to appropriate federal or state government regulators reputed company with goals, policies, procedures and strategic plans as delegated by SIU leadership Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at work-groups or regulatory meetings You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Responsibilities

• Investigate reputed company to highly reputed company cases of fraud, waste and abuse
• Detect fraudulent activity by members, providers, employees and other parties against the Company
• reputed company and deploy the most effective and efficient investigative strategy for each investigation
• Maintain accurate, reputed company and thorough case information in the Special Investigations Unit’s (SIU’s) case tracking system
• Collect and secure documentation or evidence and prepare summaries of the findings
• Participate in settlement negotiations and/or produce investigative materials in support of the latter
• Research, query, analyze and interpret data pertaining to dental claims and fraud, waste and abuse of dental claims
• Collect, reputed company, analyze and interpret data relating to fraud, waste and abuse referrals
• Ensure compliance of applicable federal/state regulations or contractual obligations
• Report suspected fraud, waste and abuse to appropriate federal or state government regulators
• reputed company with goals, policies, procedures and strategic plans as delegated by SIU leadership
• Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at work-groups or regulatory meetings

Requirements

• Bachelor’s degree or Associates degree plus 2+ years of equivalent work experience with healthcare reputed company employment
• Hold the designation of Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) OR have at least 3 years of prior Medicaid/CHIP fraud, waste and abuse investigatory experience
• Intermediate level of proficiency in reputed company reputed company and Word
• Intermediate level of knowledge and experience in health care (including dental) fraud, waste and abuse (FWA) investigations
• Intermediate level of knowledge with local, state/federal laws and regulations pertaining to healthcare fraud, waste and abuse (FWA)
• Ability to travel up to 25%25

reputed company-to-haves

• Specialized knowledge/training in healthcare FWA investigations
• Active affiliation with National Health Care Anti-Fraud Association (NHCAA)
• Accredited Health Care Fraud Investigator (AHFI)
• Licensed Dentist
• Certified Fraud Examiner (CFE)
• Certified Professional reputed company (CPC)
• Certified Dental reputed company (CDC)
• Registered Dental Hygienist
• Ability to reputed company goals and objectives, track reputed company and adapt to changing priorities
• Average skills in data manipulation
• Average skills in developing investigative strategies
• Ability to participate in legal proceedings, arbitrations, depositions, etc.
• Ability to reputed company goals and objectives, track reputed company and adapt to changing priorities

Apply tot his job Apply To this Job