- Company: Humana
- Location: Pierre, Hughes County
- Full Time
- Pierre, Hughes County
- Apply on company site
Humana at a glance
humana.comSEC filings mentioning "Humana": 5,325 · SIC industry: Hospital & Medical Service Plans — search EDGAR
Source: Wikipedia
Join Humana's Dental Special Investigations Unit as a Fraud and Waste Lead based in Pierre, Hughes County. This full-time position offers an experienced dentist the opportunity to leverage clinical expertise in investigating complex dental fraud, waste, and abuse cases while protecting plan members and maintaining program integrity.
About the Role
As the Dental Fraud and Waste Lead, you'll drive investigative initiatives for Humana's dental programs, combining your clinical knowledge with analytical rigor to identify and resolve high-impact cases. You'll work closely with our Special Investigations Unit team to examine dental claims, review clinical documentation, and make evidence-based determinations on potential fraud and waste. Your work directly protects member benefits and ensures resources reach legitimate dental care.
What You'll Do
- Conduct comprehensive dental clinical reviews on cases flagged for potential fraud, waste, or abuse
- Analyze claim patterns, treatment frequency, and clinical appropriateness against dental standards
- Investigate dentist billing practices and treatment justifications through detailed chart reviews
- Document findings and prepare detailed investigation reports with clinical determinations
- Collaborate with claims, compliance, and legal teams on case resolution and recovery actions
- Lead special investigations unit projects and mentor team members on dental-specific fraud indicators
- Stay current on dental fraud trends and emerging patterns in dentistry billing practices
What We're Looking For
- Active dental license and clinical degree (DDS or DMD) with several years of dentistry experience
- Proven investigative skills and experience reviewing claims or clinical documentation
- Strong understanding of dental coding, billing, and treatment protocols
- Excellent analytical and problem-solving abilities with attention to detail
- Clear communication skills and ability to document complex findings professionally
- Ability to work independently while collaborating across teams in a remote-optional environment
Why Humana
Humana is a leading health insurance company committed to making healthcare more accessible and affordable. Our Dental Special Investigations Unit is at the forefront of protecting member interests and maintaining dental program sustainability across the country.
How to Apply
To apply, complete your application directly on this page, or you'll be redirected to the employer's application platform to finish submitting there.
To apply for this job please visit www.adzuna.com.
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Recent news
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Aggregated from public discussions and news; opinions are the authors’ own.
Working in Pierre, Hughes County
Weather right now in Pierre, Hughes County: checking… · Local time: · Air quality: · Daylight: · UV index: · Wind: · Pollen:
South Dakota is a landlocked state in the North Central region of the United States. It is also part of the Great Plains. South Dakota is named after the Dakota Sioux tribe, which comprises a large portion of the population and has historically dominated the territory. South Dakota is the 17th-largest by area, the fifth-least populous, and the fifth-least densely populated of the 50 United States.
🇺🇸 Relocation safety for US: Exercise Normal Caution — via Warnely, CC BY 4.0
National unemployment rate in US: 4.2% — via World Bank
Private-sector wage growth (year over year): 3.3% — via FRED
National quits rate: 1.9% — via FRED (BLS JOLTS)
GDP per capita in US: $90,027 — via World Bank
Consumer price inflation in US: 2.9% (annual) — via World Bank
Average hours worked per year in US: 1,800 — via OECD
Cost of living in South Dakota: 11.4% below the national average — via BEA
Median household income in Hughes County: $78,981 — via US Census ACS / Data USA
Nearby history: St. Charles Hotel, listed 1980 (49m away) — via National Register of Historic Places
Typical climate: average high 59°F / low 36°F year-round (summers around 85°F, winters around 12°F) — via NOAA 1991-2020 Normals
Walkability: Below average walkable (9.7/20) — via EPA National Walkability Index
Typical rent nearby: $832/mo (1BR) · $1,034/mo (2BR) — via HUD Fair Market Rents
- Elevation 449m (1,473 ft)
Source: Wikipedia (state)
Job details above are provided by the employer/source. The sections on this page are compiled from public data sources with AI assistance.
Accommodations: if you need a workplace accommodation to apply for or perform this job, see ADA.gov or EEOC.gov for guidance on your rights and how to request one.
Listing facts
- Role Dental/Dentist Fraud and Waste Lead
- Employer Humana
- Location Pierre, Hughes County
- Type Full Time
- Posted June 12, 2026
- Apply by 2026-08-01
- Country context US
- Overview Full original description on this page (336 words; rewritten for clarity, not a teaser paste)
Facts above come from this job record on Get A Job.AI — not copied from third-party review sites.
Working in Pierre, Buckeye Township, Hughes County, South Dakota, 57501, United States
South Dakota is a landlocked state in the North Central region of the United States. It is also part of the Great Plains. South Dakota is named after the Dakota Sioux tribe, which comprises a large portion of the population and has historically dominated the territory. South Dakota is the 17th-largest by area, the fifth-least populous, and the fifth-least densely populated of the 50 United States.
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