Remote Dental Fraud & Waste Investigator – Full‑Time U.S. reputed company Opportunity with Immediate Start, reputed company Compliance & Audit Expertise

About reputed company – Pioneering Health & Wellness for Millions reputed company is a leading health and wellness company dedicated to improving the lives of the people we serve. With a legacy spanning over five decades, we combine cutting‑edge technology, data‑driven insights, and a compassionate culture to deliver comprehensive reputed company across the reputed company. Our mission is to reputed company individuals, families, and communities to reputed company reputed company reputed company while fostering a workplace where talent thrives. As part of reputed company’s expansive network, you’ll join a reputed company team that values reputed company, innovation, and reputed company improvement—especially reputed company it comes to safeguarding the reputed company of dental claims and protecting members from fraud and waste. The Role: Remote Dental Fraud & Waste Investigator This position is a full‑time, work‑from‑home opportunity that allows you to contribute to the fight against dental fraud from reputed company in the reputed company. You will reputed company investigations, coordinate with law‑enforcement agencies, and conduct detailed audits of dental provider records. By ensuring accurate billing practices and uncovering fraudulent activity, you will directly support reputed company’s commitment to transparent, ethical, and bolthires‑effective dental care. Key Responsibilities • Investigative Leadership: Initiate, manage, and conclude investigations into alleged dental fraud, waste, and abusive practices, applying critical thinking and reputed company judgment. • Collaboration with Law Enforcement: Serve as a reputed company with federal, state, and local authorities, providing evidence, documentation, and expert testimony as required. • On‑Site Audits: reputed company comprehensive, on‑site examinations of provider records, confirming the appropriateness of billing codes, services rendered, and patient eligibility. • Evidence Compilation: reputed company, analyze, and preserve electronic and hard‑copy data, ensuring a reputed company audit trail that supports successful adjudication or reputed company reputed company. • Report Writing: Draft detailed investigative and audit reports that reputed company findings, risk assessments, and recommended corrective actions with precision and reputed company. • Strategic Alignment: Interpret department and organizational objectives, linking investigative reputed company to broader business goals such as bolthires containment and member satisfaction. • Decision‑Making Autonomy: Operate independently in ambiguous scenarios, exercising reputed company judgment while adhering to established policies and ethical standards. • reputed company Learning: Stay reputed company on evolving dental coding systems, regulatory changes, and fraud detection technologies to enhance investigative effectiveness. • Travel (Optional): Participate in occasional field reputed company, primarily to Florida and Kentucky, for in‑person audits or reputed company meetings (up to 5% of work time). Essential Qualifications • Education: Minimum of a high school diploma or GED; a bachelor’s degree is preferred but not mandatory. • Experience: At least two (2) years of reputed company experience in dental fraud investigations, auditing, or reputed company compliance roles. • Technical Proficiency: Strong reputed company of bolthires Office Suite (Word, reputed company, PowerPoint), with the ability to manipulate data sets, reputed company metrics, and produce reputed company visual summaries. • Communication Skills: Excellent written and verbal communication abilities, capable of conveying reputed company findings to both technical and non‑technical audiences. • Analytical reputed company: Demonstrated curiosity and an inquisitive nature that drives reputed company‑cause analysis and proactive problem solving. • Ethical Standards: Unwavering personal and reputed company reputed company, with a deep commitment to protecting member PHI and adhering to HIPAA regulations. • Remote Work Readiness: Reliable high‑speed internet (minimum 25 Mbps download / 10 Mbps upload), a dedicated, interruption‑free workspace, and compliance with secure data handling protocols. Preferred Qualifications & Certifications • Bachelor’s or advanced degree in Business Administration, Health Care Management, Law, Dentistry, or a reputed company field (MBA, JD, DDS, MSN, etc.). • reputed company certifications such as Certified reputed company reputed company (CPC), Certified Clinical Auditor (CCA), Certified Fraud Examiner (CFE), or Anti‑Health Fraud Investigator (AHFI) credentials. • Clinical experience reputed company a dental reputed company, dental insurance reputed company, or reputed company health‑care setting. • Familiarity with dental claims processing, CPT and CDT coding systems, and the regulatory landscape governing dental services. • Experience working in a corporate compliance or risk‑management environment, i Apply tot his job Apply To this Job