Sun Life

The Clinical Investigator 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.. 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.. Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives.

investigator

Job Description : **Must be located in New Oklahoma**At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America.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. The Clinical Investigator 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 Clinical Investigator is responsible for working with providers to educate, impose corrective action and to reach case resolution. 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, preferredDo you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.Not ready to apply yet but want to stay in touch? to stay connected until the time is right for you!Life is brighter when you work at Sun LifeExcellent benefits and wellness programs to support the three pillars of your well-being – mental, physical and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and moreRetirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account A flexible work environment with a friendly, caring, collaborative and inclusive culture Great Place to Work® Certified in Canada and the U.S. Named as a “Top 10” employer by the Boston Globe's “Top Places to Work” two years runningAll qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. We consider various factors in determining actual pay including your skills, qualifications, and experience. In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits.Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at to learn more.At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.#LI-remoteAt Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.For applicants residing in California, please read our employee Job Category: Claims - Health & DentalPosting End Date: 30/07/2024n

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