FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in analyzing claims data to identify fraud, waste, and abuse while ensuring compliance with Medicare regulations and state guidelines. Proficient in managing client relationships and conducting investigations with a focus on dental utilization management.
Highest-signal resume keywords
Claims Data AnalysisDental Utilization ManagementFraud InvestigationEffective CommunicationAttention to Detail
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AnalysisDental Radiograph InterpretationUtilization ReportingInvestigative AnalysisOverpayment NegotiationWorkflow ManagementContractual ReportingClinical KnowledgeDental TerminologyData Querying
Soft Skills
Effective Oral CommunicationBusiness Writing SkillsInterpersonal SkillsOrganizational SkillsAdaptability
Tools & Technologies
ExcelWordOutlookAdobeFraud Tracking Database
Certifications & Qualifications
Licensed Registered Dental Hygienist
Industry Keywords
Provider FraudWasteAbuseMedicare RegulationsState Medicaid GuidelinesDentaQuest Office Reference ManualClient RelationshipsInvestigative CommunicationsDepartmental PoliciesClinical Decisions
About the role
Key responsibilities & impact- Conduct retrospective reviews of paid claims and analyze claims data to identify provider fraud, waste, or abuse
- Interpret dental radiographs and utilization reports
- Query data and conduct comprehensive drill-down analysis to identify utilization patterns and trends
- Investigate provider and member fraud and abuse in assigned markets
- Manage multiple clients and associated provider networks
- Collaborate with DentaQuest Dental Directors to support accurate and defensible clinical decisions
- Ensure audit decisions comply with Medicare regulations, State Medicaid Guidelines, the DentaQuest Office Reference Manual, and plan benefit limitations
- Assist with overpayment negotiations and provider corrective action
- Implement and update client Fraud, Waste, and Abuse processes
- Maintain client and agency relationships and manage investigative communications
- Lead client-facing meetings related to investigations
- Track investigative cases in the internal fraud tracking database
- Manage workflow, contractual obligations, and departmental metrics
- Prepare recovery documents and client contractual reports
- Maintain relationships with state Medicaid agencies and state and federal law enforcement
- Assist in evaluating departmental policies and procedures
Requirements
What you’ll need- Must reside in the state of Iowa
- Licensed Registered Dental Hygienist is preferred
- 3+ years of clinical experience and/or related investigative business experience
- Experience in Dental Utilization Management or Review is preferred
- Knowledge of general computer software, including Excel, Word, Outlook, and Adobe
- Clinical experience and knowledge of dental procedures and terminology required
- Effective oral communication and business writing skills required
- Attention to detail, accuracy, and organizational skills
- Effective interpersonal skills
- Ability to prioritize and adapt to changing priorities
Benefits
Comp & perks- Generous vacation and sick time
- Paid family, parental and adoption leave
- Medical coverage
- Company-paid life and AD&D insurance
- Disability programs
- Partially paid sabbatical program
- 401(k) employer match
- Stock purchase options
- Employer-funded retirement account
- Flexible, inclusive and collaborative work environment
- Career growth support
- Discretionary annual incentive award based on individual and business performance