Sun Life: Iowa Clinical Investigator Consultant - Must Reside in Iowa

Salary: $54,100 - $81,200 | Location: Remote/Hybrid Position

Are you a skilled investigator with a background in dental health? Sun Life, one of the largest providers of employee and government benefits in the US, is seeking a Clinical Investigator Consultant to join their team. This role offers a competitive salary and the opportunity to work remotely or in a hybrid model, with a focus on preventing and detecting fraud, waste, and abuse in the dental industry.

Sun Life U.S. is dedicated to providing approximately 50 million Americans with access to quality care and coverage. With a portfolio of benefits and services including dental, vision, disability, and life insurance, Sun Life is committed to making a positive impact on the lives of its customers, partners, and communities. Join their team of over 6,400 employees and associates, and help make a difference in the lives of millions of Americans.

Key Responsibilities:

• Conduct retrospective reviews of paid claims and analyze claims data to identify provider fraud, waste, or abuse.
• Utilize in-depth analysis, peer analysis, trend analysis, and statistical analysis to identify providers with unusual utilization patterns.
• Manage all contractual obligations related to fraud, waste, or abuse for assigned clients.
• Maintain professional relationships with clients and collaborate with them to educate and take corrective action against fraudulent activities.
• Work closely with dental directors to make accurate and defensible clinical decisions.
• Ensure compliance with regulations and guidelines while negotiating overpayments with providers.
• Assist in developing and updating client processes related to fraud, waste, and abuse.
• Track investigative cases and maintain effective communication with providers, clients, and other relevant parties.

Job Requirements:

• Licensed Registered Dental Hygienist preferred.
• 3+ years of clinical experience and/or related investigative business experience.
• Knowledge of general computer software and dental terminology.
• Strong communication, attention to detail, and organizational skills.
• Ability to prioritize and adapt to changing priorities.
• Experience in dental utilization management or review preferred.

Perks and Benefits:

• Competitive salary range based on skills and experience.
• Comprehensive benefits package, including generous vacation and sick time, parental and adoption leave, medical coverage, and retirement plans.
• Flexible, inclusive, and collaborative work environment.
• Opportunities for career growth and professional development.
• Recognition as a top employer in communities across the US and Canada.

Apply here

Join Sun Life and make a positive impact on the lives of millions of Americans while enjoying a fulfilling and rewarding career. Apply now!