Dental​/Dentist Fraud and Waste Lead

** 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 finding 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, as well as perform peer to peer reviews with other dentists.

They will also have the pleasure of providing continued education on dental industry standards and trends to a team of 5 other Dental Investigators within the development of fraud, waste and abuse concepts.

+ Complete all clinical reviews associated with dental fraud, waste and abuse investigations and create a recommendation on the case direction.

+ Stay up to date on all dental industry standards and provide education and guidance to creating new data tools to review provider outliers

+ Coordinates investigation with law enforcement authorities as well as assembles evidence and documentation to support successful adjudication, where appropriate.

+ Conducts on-site audits of provider records ensuring appropriateness of billing practices.

+ Prepares complex investigative and audit reports and advises executives to develop functional strategies for dental fraud, waste and abuse case on matters of significance.

** Use your skills to make an impact*
* ** WORK STYLE:
** Remote/work le 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).

** What you need for success!

- Required 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

** Preferred Qualifications*
* + 5+ years of investigative or auditing experience of dental related claims

+ Knowledge of Medicare regulations

+ Knowledge of Medicaid regulations

** Additional Information - How we Value You*
* ** Work at Home Requirements*
* -    WAH requirements:
Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

-    A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

-    Satellite and Wireless Internet service is NOT allowed for this role.

-    A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

** Additional Information - How We Value You*
* -    Benefits starting day 1 of employment

-    Competitive 401k match

-    Generous Paid Time Off accrual

-    Tuition Reimbursement

-    Parental Leave

** Interview Format*
* As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of…