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Clinical Investigator Consultant, DentaQuest (Oklahoma)
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Full-time
- 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.
- 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.
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