Licensed Clinical Investigator

Job Summary

A company is looking for a Clinical Investigator Consultant to conduct investigations related to fraud, waste, and abuse in dental claims.

Key Responsibilities

• Conduct retrospective reviews of paid claims and analyze claims data to identify provider fraud, waste, or abuse
• Perform in-depth analysis, including peer and statistical analysis, to assess provider utilization patterns
• Manage professional relationships with clients and oversee all aspects of the investigative process

Required Qualifications

• 5+ years of dental clinical experience required
• Licensed Registered Dental Hygienist is preferred
• Experience in Dental Utilization Management or Review is preferred