Dental Fraud Evaluation Professional

Dental Fraud Evaluation Professional at Humana in Boise, Idaho, United States Job Description Become a part of our caring community The Dental/Financial Risk Evaluation Professional 2 is responsible for supporting the development, implementation and monitoring of dental/financial risk. The Dental/Financial Risk Evaluation Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. This role is a critical component within the Fraud Research Analytics and Concepts (FRAC) Department and the Special Investigations Unit (SIU). It serves as the primary resource for the detection, prevention, and mitigation of fraudulent activities in the dental space across all lines of business, including Medicaid. You will support regulatory and internal compliance requirements, financial risk mitigation strategies, and fosters essential bi-weekly collaboration between FRAC and the SIU Dental team. You will be a primary referral source for the Special Investigations Unit, enhancing investigative efficiency through the referral of providers for formal investigations that yielded substantial findings and payment accuracy. Furthermore, you will be a critical liaison between analytics, payment integrity operations, and Dental SIU, ensuring the preservation of dental context and data integrity throughout the fraud evaluation process. Use your skills to make an impact Required Qualifications + Minimum 2 years of professional experience working with dental claims data, including familiarity with claims submission, adjudication, and analysis processes + Comprehensive expertise in Clinical Dental Terminology (CDT), including accurate application of CDT codes for claims processing and data analysis + Demonstrated knowledge/experience in dental clinical concepts and practices, including the ability to interpret and apply clinical guidelines within dental contexts + Expertise in Microsoft Excel, including advanced skills in utilizing Pivot Tables for data summarization, analysis, and reporting Work-At-Home Requirements + At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggested + Satellite, cellular and microwave connection can be used only if approved by leadership + Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office ass To view full details and how to apply, please login or create a Job Seeker account

Created: 2026-04-02