Rhsc
Supervisor, Focused Review
Okemos, MI · Staff+
Sponsorship not specifiedDetected 23 days ago
SQLData VisualizationComplianceAuditingResearchLeadershipCommunicationMentoringClaims Management
About the role
- We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.
- At Delta Dental, we celebrate our All In culture.
- It's a mindset, feeling and attitude we wrap around all that we do - from taking charge of our careers, to helping colleagues and lending a hand in the community.
Responsibilities
- Supervises and monitors the daily administrative and technical functions of the Focused Review SIU teams, data research and review, and audit and investigation activities to ensure efficient, compliant operations that support departmental and corporate goals and objectives.
- Supports staff recruitment, onboarding, and development by assisting with interviewing, training, mentoring, and evaluating team members to promote accountability and achievement of individual and team objectives.
- Assists in developing and implementing departmental strategies, goals, and objectives to support continuous improvement and operational excellence.
- Supports budget monitoring and resource allocation for the Focused Review SIU teams as directed by management.
- Implements and enforces policies, procedures, and standards for audits and investigations, and assists in preparing departmental reports and analyzing business processes to ensure compliance with regulatory requirements for both commercial and government programs.
- Builds and maintains collaborative relationships with business partners to provide operational support, clarify requirements, and promote effective use of SIU services and solutions.
- Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
Requirements
- Position requires a bachelor's degree in business administration or related field and five years of experience auditing or analyzing data in the insurance industry.
- ability to use data extraction and analytic tools, word processing, spreadsheet, and presentation software skills
- the ability to interpret contract language related to fraud, waste, and abuse and claims processing
- and the ability to resolve complex problems using independent judgment.
Nice to have
- Previous leadership experience is preferred, as well as experience with claims processing software or analyzing group or provider contracts in the insurance industry.
- Experience with SQL, ACL, and Tableau preferred.
- CFE, CIA, AHFI also preferred.
Visa & Work Authorization
- out regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, he
This listing is sourced directly from Rhsc's careers page and normalized into a canonical job model.