Immediately Require Dental Fraud and Waste Investigator: REMOTE/WORK AT HOME (Anywhere in the US) in Florida
Job title: Dental Fraud and Waste Investigator: REMOTE/WORK AT HOME (Anywhere in the US)
Company: Humana
Job description: Description
The Fraud and Waste Professional conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Responsibilities
The Dental Fraud and Waste Professional coordinates dental investigations with law enforcement authorities. 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. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
High school diploma or equivalent
At least 2 years of dental investigations or auditing experience
Computer literate (MS Word, Excel) with ability to analyze data to metrics
Strong organizational, interpersonal, and communication skills
Inquisitive nature
Strong personal and professional ethics
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Possibly up to 5% travel, mostly to Florida & Kentucky
This role is 40 hours, Monday-Friday. Typical business hours are 7AM-6PM EST, but might vary depending on business needs.
Preferred Qualifications
Bachelors or Advanced degree and/or certifications (DDS, MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI).
Previous clinical experience working in the dental industry
Understanding of dental industry, claims processing and investigative process development.
Experience in a corporate environment and understanding of business operations
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
Parent Leave
Go365 perks for well-being
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, 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 questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
#ThriveTogether #WorkAtHome
Scheduled Weekly Hours
40
Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$63,400 - $87,400 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits 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.
Expected salary: $63400 - 87400 per year
Location: Florida
Apply Now
Company: Humana
Job description: Description
The Fraud and Waste Professional conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Responsibilities
The Dental Fraud and Waste Professional coordinates dental investigations with law enforcement authorities. 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. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
High school diploma or equivalent
At least 2 years of dental investigations or auditing experience
Computer literate (MS Word, Excel) with ability to analyze data to metrics
Strong organizational, interpersonal, and communication skills
Inquisitive nature
Strong personal and professional ethics
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Possibly up to 5% travel, mostly to Florida & Kentucky
This role is 40 hours, Monday-Friday. Typical business hours are 7AM-6PM EST, but might vary depending on business needs.
Preferred Qualifications
Bachelors or Advanced degree and/or certifications (DDS, MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI).
Previous clinical experience working in the dental industry
Understanding of dental industry, claims processing and investigative process development.
Experience in a corporate environment and understanding of business operations
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
Parent Leave
Go365 perks for well-being
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, 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 questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
#ThriveTogether #WorkAtHome
Scheduled Weekly Hours
40
Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$63,400 - $87,400 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits 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.
Expected salary: $63400 - 87400 per year
Location: Florida
Apply Now