Iowa Clinical Investigator Consultant

Sun Life

Clinical Investigator analyzing fraud and waste in dental claims for Sun Life's benefit programs. Responsible for client relationships and compliance with regulatory standards in the investigative process.

Posted 5/15/2026full-timeDes Moines • Iowa • 🇺🇸 United StatesMid-LevelSenior💰 $54,100 - $81,200 per yearWebsite

About the role

Key responsibilities & impact

Responsible for clinical interpretation of dental radiographs
Independently interpret utilization reports to detect patterns and potential areas of fraud, waste or abuse
Query data to conduct comprehensive drill down data analysis to detect patterns and trends of under and over utilization
Investigate provider and member fraud and abuse in assigned markets
Manage multiple clients and associated provider networks related to fraud, waste and abuse investigation
Work with and in consultation with DentaQuest Dental Directors during the investigative process to assure accurate and defensible clinical decisions
Responsible for the accuracy of all investigative decisions
Assure all audit decisions are in compliance with Medicare regulations, State Medicaid Guidelines, and plan benefit limitations
Assist management in overpayment negotiations with providers related to the results and findings of an investigation
Track all investigative cases in accurate timeline format in internal fraud tracking database
Responsible for the development of interdepartmental relationships to assure all issues related to fraud, waste or abuse are identified and appropriately investigated

Requirements

What you’ll need

Licensed Registered Dental Hygienist is preferred
3+ years clinical experience and/or related investigative business experience
Experience in Dental Utilization Management or Review, preferred
Knowledge of general computer software (Excel, Word, Outlook, Adobe)
Clinical experience and knowledge of dental procedures and terminology is required
Effective oral communication and business writing skills are required
Attention to detail, accuracy, and organizational skills are essential
Effective interpersonal skills are essential
Ability to prioritize and adapt to changing priorities is essential

Benefits

Comp & perks

Generous vacation and sick time
Market-leading paid family, parental, and adoption leave
Medical coverage
Company paid life and AD&D insurance
Disability programs
Partially paid sabbatical program
401(k) employer match
Stock purchase options
Employer-funded retirement account
Flexible, inclusive, and collaborative work environment

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical interpretationdata analysisfraud investigationutilization managementdental proceduresdental terminologyaudit complianceoverpayment negotiationpattern detection

Soft Skills

oral communicationbusiness writingattention to detailaccuracyorganizational skillsinterpersonal skillsability to prioritizeadaptability

Certifications

Licensed Registered Dental Hygienist