Fraud Prevention and Recovery Unit Supervisor Employee

DentaQuest

Employee

TELECOMMUTE – Milwaukee, WI

2/19/21

Job Description

SUPERVISOR, SPECIAL INVESTIGATION UNIT

(HEALTHCARE – REMOTE)

Milwaukee, Wisconsin, United States

Remote Opportunity:Yes

Requisition Number:3175

About:

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.

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 …

Insurance , Risk Management , Medical & Health , Dental

Milwaukee, WI