Government Programs Appeals and Grievances Compliance Specialist
Delta Dental of Michigan
full-time
Posted on:
Location Type: Hybrid
Location: Okemos • Missouri • United States
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About the role
- 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
Requirements
- Bachelor’s degree in accounting, business administration, criminal justice, health care administration, dental assisting or hygiene, or a related field
- Three years of resolving complaints in the dental insurance industry or six years of experience in a position requiring knowledge of dental office billing and record keeping practices
- Previous experience supporting an anti-fraud/abuse program and/or audit/compliance monitoring activities preferred
- Strong verbal and written communication skills
- Strong analytical skills
- Ability to work independently and as part of a team
- Ability to manage multiple assignments with competing deadlines
- Ability to identify and resolve problems using independent judgment
Benefits
- Medical, dental, and vision coverage
- Short- and long-term disability
- Life insurance
- 401(k) savings plans
- Flexible spending accounts
- Tuition reimbursement or educational assistance
- Annual incentive compensation based on annual business goals
- Eight hours of paid volunteer time each year
- Access to an on-staff health coach and personal trainer
- Many other perks
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
compliance oversightquality auditsoperational guidancetraining materials developmentprocedures maintenanceaudit coordinationappeal reviewsgrievance reviewsanti-fraud program supportbilling and record keeping practices
Soft Skills
verbal communicationwritten communicationanalytical skillsindependent workteam collaborationproblem-solvingtime managementorganizational skills
Certifications
Bachelor’s degree