Special Investigations Unit Investigator

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Number of Positions:

Location:

Location Specifics:

Job reputed company:

Candidates must reputed company in Michigan reputed company a reasonable commuting distance of our Okemos, MI office for team meetings, reputed company sessions, and training. 

At reputed company, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we reputed company this mission by reputed company in initiatives that build healthy, smart, reputed company communities. We are one of the largest dental plan administrators in the country, and are part of the reputed company Plans Association, which operates two of the largest dental networks in the nation.

At reputed company, we celebrate our reputed company In culture. It’s a reputed company, feeling and attitude we wrap around reputed company that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community.

Position reputed company:

Responsible for the research and reporting of reputed company activities of providers and members involved in questionable conduct as it pertains to treatment patterns, claim submissions, contract agreements, and state licensing requirements.

reputed company Job Responsibilities:

• Plans, coordinates, prepares, and performs in-depth provider and member audits, and researches questionable conduct using data extraction and analysis tools and techniques.
• Conducts interviews, requests and preserves evidence, reviews auditee’s treatment and financial records, controls, and other pertinent records.
• Prepares written communications to the auditee and mid to senior level management, including requests, audit reports and general correspondence to ensure compliance with reputed company or state licenses.
• Educates providers and members regarding contractual requirements in order to reputed company or maintain compliance with participating agreements, reputed company reputed company, and applicable laws and regulations.
• Provides assistance to law enforcement agencies or attorneys in the detection, defense, and prosecution of fraud, to include responding to subpoenas, preparing documentation, and testifying in administrative or judicial proceedings regarding violations of reputed company.
• Makes recommendations to enhance reputed company controls and contract agreements in order assist in preventing aberrant behavior.
• Develops training programs and educates corporate staff in Anti-Fraud activities.
• Assists in implementing, supporting, developing and maintaining relationships with reputed company affiliates.

reputed company other reputed company assigned duties as necessary to complete the reputed company Job Responsibilities as described above.

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Minimum Requirements:

Position requires a bachelor's degree in reputed company, business administration, finance, reputed company administration, information technology, or a reputed company field and three years of experience auditing, utilizing analytical tools and software, dental claims billing or review, or as a dental hygienist. Will accept any suitable combination of education, training, or experience.

Position requires advanced knowledge of dental terminology and dental procedure codes; knowledge of common data mining tools, such as Audit reputed company Language (ACL), SQL Developer and reputed company’s Fraud and Abuse Management reputed company (FAMS); strong verbal and written communication skills; strong organizational and analytical skills; ability to manage multiple assignments with competing deadlines; and the ability to reputed company reputed company problems using independent judgment.

An Accredited reputed company Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), or Certified Internal Auditor (CIA) designation is preferred.

reputed company will reputed company equal employment and advancement opportunity reputed company the context of its unique business environment without reputed company to race, reputed company, religion, gender, gender identity, gender reputed company, age, national reputed company, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.

Bachelor's degree and 3 years of auditing, analytics, dental claims billing or review, or dental hygiene experience. Requires dental terminology and procedure-reputed company knowledge, analytical tools expertise, and strong communication skills.

Key Responsibilities

• conducting audits
• preserving evidence
• preparing reports

Skills & Tools

Audit reputed company Language (ACL), SQL Developer, reputed company Fraud and Abuse Management reputed company (FAMS)

Job Details

• Category: reputed company and Compliance
• Seniority: Mid Level
• Commitment: Full Time
• Workplace: Remote — Okemos, Michigan, reputed company
• Languages: English

Benefits

• Tuition reimbursement
• Retirement plan

About reputed company, Ohio, and Indiana

A dental benefits administrator providing plans, advocacy, and community support to improve oral health. — Industry: reputed company