Supervisor, Special Investigation Unit (Healthcare - Remote)

Location: Milwaukee, Wisconsin, United States

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Remote Opportunity: 1

Requisition Number: 3175

Position Title: Supervisor, Fraud Prevention & Recovery

External Description:

Job Summary
The Fraud Prevention and Recovery Unit Supervisor is responsible for working with the investigative team to ensure compliance with all contractual obligations. The Supervisor assists in assuring departmental goals are met; ensuring appropriate development, training, and performance management of resources occurs. The Fraud Prevention and Recovery Supervisor is responsible for providing day to day supervision to the Unit’s investigators and their activities. The Supervisor reports to the Manager of Fraud Prevention and Recovery and VP for Fraud Prevention & Recovery.

Primary Job Responsibilities
• Responsible for the training of new investigators and ongoing training of the investigative staff.
• Oversees and tracks contractual obligations to clients and public agencies to ensure investigators are in compliance with client specific contractual obligations.
• Oversees all new business implementations to assure processes are developed to meet contractual obligations.
• Works with investigative team to assure comprehensive oversight of contracted dentists to prevent fraud and abuse
• Develops workflows between other intersecting departments to ensure efficient and accurate outcomes.
• Work with Fraud Prevention and Recovery Management to oversee the Fraud Prevention and Recovery Unit and keep them updated and apprised as appropriate on team and/or client issues.
• Assist in the hiring process, including interviewing candidates.
• Assist in the ongoing evaluation of departmental policies and procedures.
• Completes the preparation of performance evaluations in accordance with company policy.
• Ensures that Investigators meet all contractual reporting requirements.
• Ensures Investigators are meeting all state and federal requirements related to the investigation of fraud waste and abuse. 
• Monitor Investigator’s monthly metrics and address deficiencies.
• Monitor attendance and approved time off for all direct reports.
• Responsible for compilation of data for client audits
• Assist department management in development of and implementation of client required corrective action plans.
• Ensures Investigators are meeting all state and federal requirements related to the investigation of fraud waste and abuse. 
• Responsible to meet with Investigators on an ongoing basis to assure they are in compliance with department policies and procedures and client contractual obligations.
• Ensures Investigators follow all team policies and processes. 
• Serves as liaison for issues between internal departments and external clients.
• Read and interpret x-rays, photos, and patient charts.
• Other duties as needed or required.

Job Qualifications
Required:
• Bachelor’s degree in related field, or equivalent experience in fraud prevention management, preferred.
• 7 +years of experience in clinical dentistry or related business experience
• 5 + years of applicable Experience in Utilization Management and/or Utilization Review
• (Dental) Fraud and Abuse Experience, preferred.
• Excellent analytical and problem-solving skills.
• Strong computer skills including Microsoft Office applications, and general reporting software.
• Ability to present to professionals – clients, colleagues, senior leaders.
• Excellent math capabilities; including the ability to analyze and organize data.
• Strong attention to detail.
• Ability to make appropriate decisions.
• Excellent organizational skills.
• Operate with minimal direction
• Excellent communication skills: written, verbal and interpersonal.
• Ability to work well with others at all levels of the organization.
• Ability to work under pressure.
• Ability to identify and escalate critical conditions.
• Attends additional training as requested/deemed necessary

Physical Demands
• Incumbent must be able to communicate effectively. 
• Requires overall light physical effort (up to 25lbs.) 
• Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal compute). 
• Ability to travel or move about within and outside serviced facilities required. 
• Incumbent works primarily in either a private or shared office environment.
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The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform this position.



City: Milwaukee

State: Wisconsin

Community / Marketing Title: Supervisor, Special Investigation Unit (Healthcare - Remote)

Company Profile:

We believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.

Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it. 

To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.

The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.

Company Profile Job:

At DentaQuest, we believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.

Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it. 

To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.

The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.

Location_formattedLocationLong: Remote, Connecticut US

CountryEEOText_Description: In accordance with our Compliance Plan, employees must conduct business in accordance with applicable laws, regulations, professional standards and ethical standards and report potential compliance or ethical issues to manager or Compliance Officer. Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please see Human Resources for additional information regarding this Program. Equal Employment Opportunity Statement: We are committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, or sexual orientation.

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