Delta Dental of Michigan

Compliance

• Leads the Government Programs utilization management (UM) compliance functions
• Ensures adherence to URAC/NCQA standards
• Drafts and maintains procedures, materials and reports for compliance
• Analyzes and monitors UM and CR compliance metrics
• Identifies potential compliance risks or barriers to maintaining URAC/NCQA accreditation
• Supports regulatory and accreditation-related audits
• Partners with department leadership to support compliance and quality goals
• Participates in developing internal educational programs on compliance requirements
• Maintains detailed project plans for URAC/NCQA standards monitoring
• Oversees the URAC/NCQA survey process for utilization management

Senior Utilization Management Compliance and Accreditation Specialist

Data Analyst

• Supports Medicaid and government-sponsored dental programs, including data reporting, compliance tracking, and analytical support
• Prepares, validates, and submits state Medicaid reporting in accordance with contractual, regulatory, and compliance requirements
• Supports Medicaid state compliance reporting, ensuring accuracy, timeliness, and documentation standards are met
• Oversees and tracks Secret Shopper reporting, including data collection, trend analysis, and performance tracking across reporting periods
• Responds to ad hoc data requests from internal partners
• Performs routine data analysis to identify trends, gaps, and potential compliance risks related to government program requirements
• Assists with data quality checks, reconciliation, and issue resolution across multiple data sources
• Maintains organized documentation supporting reported data, methodologies, and assumptions for audit and compliance purposes
• Collaborates with cross-functional teams to understand data needs and translate business requirements into accurate reports
• Participates in process improvement efforts to enhance reporting efficiency, accuracy, and repeatability

Government Programs Data Analyst

• 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

Senior Utilization Management Compliance and Accreditation Specialist

Government Programs Data Analyst

Government Programs Appeals and Grievances Compliance Specialist