SIU Investigator - #255711

The SIU (Special Investigations Unit) Investigator plays a vital role in protecting the integrity of Liberty Dental Plan’s operations by identifying and mitigating health care fraud, waste, and abuse. This position is responsible for conducting detailed investigations, developing and analyzing data reports, and working with both internal teams and external partners such as law enforcement. The ideal candidate will have strong investigative skills, a solid understanding of dental claims and coding, and the ability to independently manage multiple cases efficiently. This is an exciting opportunity for someone passionate about upholding compliance and ethical standards in health care.

Job Location:

6385 S Rainbow Blvd #200, Las Vegas, NV 89118

This is a hybrid position.

Essential Duties & Responsibilities

• Triage and manage caseloads, including investigations of potential healthcare fraud by providers or members.
• Research allegations of fraud, waste, and abuse (FWA) to detect and deter violations across all Plan programs.
• Prepare comprehensive documentation and reports for internal tracking and regulatory requirements.
• Analyze claims data to identify trends and potential fraud leads.
• Collaborate with internal departments (Compliance, Legal, Provider Relations) and external law enforcement when needed.
• Prepare case files for law enforcement referrals and provide testimony in legal proceedings.
• Use data mining and statistical tools to detect billing anomalies and prevent future fraud.
• Develop corrective action plans with providers and monitor resolution of FWA issues.
• Attend annual seminars/webinars to remain current on industry trends and practices.
• Assist SIU Leadership and legal counsel with investigations and litigation as required.
• Contribute to the development of departmental tools and benchmarks for performance evaluation.
• Perform other duties or special assignments as needed.
  
  

Education Requirements

• Preferred: Bachelor’s Degree in a related field or equivalent experience.
  
  

Years Of Experience

• Minimum: 1–3 years of investigative or dental audit experience or dental claim processing, healthcare fraud investigations, or dental office management.
  
  

Specific Skills/Knowledge

• Knowledge of insurance reimbursement methodologies and dental claim coding.
• Proven investigative skills with attention to detail and analytical thinking.
• Familiarity with managed care systems and fraud detection strategies.
• Proficiency in Microsoft Office (especially Excel), internet, and social media research.
• Advanced skills in Excel functions, including pivot tables and formulas.
• Ability to manage multiple priorities and meet deadlines independently.
• Knowledge of dental terminology, procedures, and contracts.
• CPC/AAPC certification preferred (required for Investigator III), or equivalent experience.
• Bilingual in Spanish preferred.
  
  

Location

Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.

This is a hybrid position: 6385 S Rainbow Blvd #200, Las Vegas, NV 89118

Job Location:

What Liberty Offers

Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That’s why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity.

Our first-class benefits package supports employees and their dependents with:

• Competitive pay structure and savings options to help you reach your financial goals.
• Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.
• Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.
• 100% employer-paid dental coverage for employees and eligible dependents.
• Vision insurance with low-cost premiums for employee-only coverage and dependents.
• Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.
• Flexible Spending Accounts for healthcare and dependent care expenses.
• Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.
• Long-term disability coverage.
• Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts.
• Employee Assistance Program (EAP) to support mental health and well-being.
• Generous vacation and sick leave policies, with the ability to roll over unused time.
• 10 paid company holidays.
• Tuition reimbursement for eligible educational expenses.
• Remote or hybrid work options available for various positions.
  
  

Compensation

In the spirit of pay transparency, the base salary range for this position is $50,000 - $70,000, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions.

Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth.

Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture.

Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve.

We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.

Sponsorship and Relocation Specifications

Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled.

No relocation assistance or sponsorship available at this time.