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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 associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

• Advanced degree
• Experience applying SQL-based methods for data evaluation, including writing and optimizing queries for extracting and analyzing dental claims or related healthcare data
• Prior experience working in a dental office environment, demonstrating understanding of dental billing practices, and patient care coordination

Additional Information

• As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.
• If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$65,000 - $88,600 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 04-02-2026

About us
 

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.