Delta Dental of Michigan

Compliance

• Provides compliance oversight and operational guidance to management and staff responsible for resolving member appeals and grievances
• Develops, maintains, and delivers training materials and job aids
• Conducts comprehensive monthly quality and compliance audits of appeals and grievances
• Develops and maintains departmental procedures, controls, and reference materials
• Supports internal and external audits by coordinating requests, compiling audit samples and supporting evidence
• Serves as a compliance and process subject matter expert during audits and meetings
• Assists in assigning work and performing appeal and grievance reviews
• Provides day-to-day compliance support to the appeals and grievances team

Government Programs Appeals and Grievances Compliance Specialist