The Senior Dental Investigation Analyst, Investigation Services is responsible for applying Group Benefits and dental knowledge to identify, investigate and prevent dental fraud and abuse.
Excellent customer service skills, problem-solving abilities and attention to detail are key attributes required for success in this role on the Dental Abuse Management Team.Position Responsibilities:
Data Analysis and Profiling:
Perform risk-based data profiling to identify trends and outliers for further investigation.Audit Leadership:
Lead and support audit programs, making decisions on investigations, and preparing concerns letters and complaints.Investigations and Interviews:
Conduct investigations to successful conclusions, including interviews with plan members and service providers.Mentorship and Knowledge Maintenance:
Mentor junior staff in data analysis and investigative techniques, while staying updated on audit tools and technology.Stakeholder Engagement and Communication:
Interact with internal and external stakeholders and assist with creating risk-related communication materials for Senior Management.Required Qualifications:
University degree or equivalent work experience.Knowledge of Group Benefits.Knowledge of the Canadian healthcare environment, service delivery model and regulation.Knowledge of dental codes and billing practices.Knowledge of fraud and abuse risk, and techniques to manage risk.Preferred Qualifications:
Dental Assisting or Dental Hygiene experience is an asset.Strong research, problem-solving and decision-making skills.Ability to manage contentious interactions with various stakeholders.Excellent oral communication (both phone and face-to-face) and written communication skills.Intermediate data analysis skills with expertise using Excel and other data mining software.Demonstrated investigation skills with attention to detail.Ability to be creative, critical and aggressive in managing audit and investigative activities.Organizational skills and the ability to manage multiple conflicting priorities.Bilingual is an asset.When you join our team:
We'll empower you to learn and grow the career you want.We'll recognize and support you in a flexible environment where well-being and inclusion are more than just words.As part of our global team, we'll support you in shaping the future you want to see.
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