Iowa Clinical Investigator Consultant - Must Reside in Iowa

The Opportunity

The Clinical Investigator is responsible for the retrospective review of paid claims and analysis of claims data to identify provider fraud, waste or abuse. They will conduct in-depth analysis, peer analysis, trend analysis and statistical analysis to identify providers whose utilization patterns are outside of the expected norm from their peers in their assigned markets. They will have full responsibility for all contractual obligations for their assigned clients related to fraud, waste or abuse. The Clinical Investigator is responsible for the professional relationship with assigned clients related to fraud, waste and abuse and is responsible for all aspects of the investigative process from identification, initiation, completion and referral of the investigation as applicable.

The Investigator works closely with clients, managed care organizations, state agencies and law enforcement related to their investigations as required.

What You Will Bring with You

• Licensed Registered Dental Hygienist is preferred.
• 3 + years clinical experience and/or related investigative business experience.
• Experience in Dental Utilization Management or Review, preferred.
• Preferred Skills:
  • Knowledge of general computer software (Excel, Word, Outlook, Adobe).
  • Clinical experience and knowledge of dental procedures and terminology is required.
  • Effective oral communication and business writing skills are required.
  • Attention to detail, accuracy and organizational skills are essential.
  • Effective interpersonal skills are essential.
  • Ability to prioritize and adapt to changing priorities is essential.

Salary

Salary Range: $54,100 - $81,200

Benefits

Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business.

We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate.

About the Role

At Sun Life, we embrace a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK. Candidate must reside in the state of Iowa.

Qualifications

• Licensed Registered Dental Hygienist is preferred.
• 3 + years clinical experience and/or related investigative business experience.
• Experience in Dental Utilization Management or Review, preferred.

Skills

• Knowledge of general computer software (Excel, Word, Outlook, Adobe).
• Clinical experience and knowledge of dental procedures and terminology is required.
• Effective oral communication and business writing skills are required.
• Attention to detail, accuracy and organizational skills are essential.
• Effective interpersonal skills are essential.
• Ability to prioritize and adapt to changing priorities is essential.

Benefits

Life is brighter when you work at Sun Life. At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth.

Pay

Salary Range: $54,100 - $81,200

Schedule

Hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK.