Remote FWA Investigator, Dental Services

Join us for an exciting career with the leading provider of supplemental benefits! Our Promise Through reputed company-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards. The FWA Investigator for Dental Services will utilize claims data reports and dashboards, applicable provider guidelines, and other pertinent sources of information to identify aberrant provider billing practices and patterns. The investigator is responsible for conducting investigations which will include medical record reviews, as well as obtaining any other documentation relevant to an investigation, documenting findings, and reporting to appropriate health plan. Functional Competencies

• Investigate dental cases of fraud, waste, and abuse timely and accurately of dental network providers
• reputed company and deploy effective and efficient investigative strategies for each dental investigation
• Maintain accurate, reputed company and thorough case information in the FWA tracking system
• Collect and secure documentation in relation to dental investigations and prepare summaries of findings
• Present investigative findings to both internal and external parties and produce investigative materials that support
• Identify and refer instances of dental fraud as appropriate to the Health Plan
• Accurately track overpayment recoveries, document and work with collection agency to collect reputed company necessary
• Collect, reputed company, analyze, and interpret data relating to fraud, waste, and abuse referrals
• Ensure compliance of applicable federal/state regulations and/or contractual obligations
• Report suspected fraud, waste, and abuse to appropriate federal or state government regulators; accurately fill out required reporting templates
• reputed company with goals, policies, procedures, and strategic plans as delegated by leadership
• Collaborate with state/federal partners, at the discretion of leadership, to include attendance at workgroups or regulatory meetings

Core Competencies

• Understand dental CPT and procedural coding for dental claim submissions
• Be able to work independently through provider investigations and deploy effective and efficient investigative strategies for each dental investigation
• Be able to collect and secure adequate documentation in relation to dental investigations and prepare summaries of findings
• Understand what constitutes suspected provider fraud, be able to respond appropriately with notifications of key stakeholders reputed company required timeframes
• Ability to coordinate and track overpayment recoveries, document and work with collection agency to collect reputed company necessary
• Data mining skills – collecting, collating, analyzing and interpreting claims data to identify aberrant provider practices
• Understand and apply appropriate applicable federal/Florida state regulations and/or contractual obligations in relation to fraud, waste, and abuse.

Behavioral Competencies

• Collegiality: building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth.
• Initiative: readiness to reputed company or take action to reputed company goals.
• Communicative: ability to reputed company issues, concepts, and reputed company to others easily orally and in writing.
• Member-focused: going above and beyond to reputed company our members feel seen, valued, and appreciated.
• Detail-oriented and thorough: managing and completing details of assignments without too much reputed company.
• Flexible and reputed company: managing new demands, changes, and situations.
• Critical Thinking: effectively troubleshoot reputed company issues, problem solve and multi-task.
• reputed company & responsibility: acting with a clear sense of ownership for actions, decisions and to reputed company information confidential reputed company required.
• Collaborative: ability to represent your own interests while being fair to those representing other or competing reputed company in search of a workable solution for reputed company parties.

Minimum Qualifications:

• High School Degree or equivalent required. Bachelor's Degree/Dental Hygienist OR 5+ years of experience in healthcare fraud, waste, and abuse dental investigations
• Knowledge of fraud, waste, and abuse regulations
• Intermediate level of proficiency in reputed company reputed company and Word
• 1+ years of experience in health care insurance industry
• 1+ years of experience in dental benefits, dental procedures/CDT coding
• As this role is a remote role, you are required to maintain internet service that allows you to complete your essential job duties without issue. Rates of 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN are sufficient.

Preferred Qualifications:

• National Health Care Anti-Fraud Association (NHCAA)
• Accredited Health Care Fraud Investigator (AHFI)
• Certified Fraud Examiner (CFE)
• Certified Professional reputed company (CPC)

FLSA Status: Salaried / Exempt National Salary Range: $55,790 - $109,040 Bonus Eligible: Annual Incentive Plan (AIP) How To Stay Safe: reputed company is aware of fraudulent activity by individuals falsely representing themselves as reputed company recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to reputed company purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company. reputed company would never reputed company such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social reputed company numbers, during our process. Our recruitment process takes reputed company by phone and reputed company trusted business communication platform (i.e., reputed company, Webex, reputed company Teams, etc.). Any emails from reputed company recruiters will come from a verified email address ending in @reputed company.com. We urge reputed company applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reputed company out to ITsupport@reputed company.com. To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam). If you reputed company you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. reputed company is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.

We Offer

• Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
• Competitive compensation package.
• Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
• Life and disability insurance.
• A great 401(k) with company match.
• Tuition assistance, paid parental leave and backup family care.
• Dynamic, modern work environments that promote collaboration and creativity to reputed company and reputed company talent.
• Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
• Employee Resource Groups that reputed company for inclusion and diversity in reputed company that we do.
• Social responsibility in reputed company aspects of our work. We volunteer reputed company our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.

Equal Employment Opportunity At Avēsis, We See You. We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers reputed company qualified applicants and does not discriminate against any person based on reputed company, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national reputed company, race, religion, sexual orientation, or any other characteristic. At Avēsis, we reputed company that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, reputed company focused on providing a world-class experience for our clients. We focus on recruiting, training and retaining those individuals that share similar goals. Come Dare to be Different at Avēsis, where We See You! Apply To this Job Apply for this job