Delta Dental of Michigan
Job Summary
At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. 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.
Position Title Compliance Specialist
Location Okemos, MI – Hybrid Position
Position Description Provide support for the day‑to‑day operations and management of the Compliance Program with respect to Delta Dental of Michigan and its affiliates and/or subsidiaries.
Primary Job Responsibilities
Implement initiatives to raise awareness of Company’s Compliance Program including planning, developing and conducting education and training activities related to compliance.
Develop training materials, implement training calendar, monitor and audit employee training records.
Monitor and evaluate documents to determine the relevance of regulatory updates that may affect member materials. Monitor document revision processes, ensuring changes are implemented from request through approval by internal and external parties and verifying accuracy of final production. Provide consistent updates to management and stakeholders on the status of implementation and highlight any risks related to timely and accurate implementation.
Manage and maintain a document repository of member and provider documents, ensuring that forms are consistent with company standards and legal, contractual and regulatory requirements.
Work with internal and external stakeholders to ensure work is prioritized and implemented by required deadlines.
Serve as a liaison for the compliance department, collaborating with key departments to confirm policies and procedures are developed and implemented to ensure compliance with applicable contract provisions, rules and regulations, including the assessment, interpretation and drafting of policy, procedure or job aids.
Advise organization and support Compliance Officer in communicating regulatory changes and implementation of compliance strategies to meet them.
Facilitate and manage coordination between compliance department and operations on new compliance efforts and initiatives.
Play a key role in the annual compliance risk assessment and collaborate to ensure proper auditing is conducted and management of identified risks is appropriate.
Maintain and analyze company’s monitored compliance efforts and identify and assess gaps.
Coordinate various committees and task forces related to company’s compliance, including management of assignments.
Facilitate and coordinate all aspects of any Medicare Advantage, Medicaid or Affordable Care Act audit, request, or inquiry by collecting, reviewing, analyzing and verifying all requested materials prior to submission, including any collaboration with the applicable operational subject matter expert required as a result of the request.
Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
Minimum Requirements Position requires a bachelor’s degree in business administration, health administration, public health/public policy or a related field and three years of compliance experience, preferably in the health insurance industry, or five years’ experience related to auditing, quality monitoring, risk management, or operations. Compliance experience within the Medicare or Medicaid industry preferred. A compliance certification is preferred. Will accept any suitable combination of education, training, or experience.
Position requires the capability to process substantial amounts of detailed information with a high degree of accuracy; demonstrated strong analytical skills, ability to efficiently manage multiple projects and effectively analyze data to develop alternative solutions; excellent interpersonal, verbal, and written communication skills; strong attention to detail and adaptability to shifting priorities and deadlines; strong organizational skills and proficiency in handling competing demands; and the ability to work independently and collaboratively within a fast‑paced team environment.
The company will provide equal employment and advancement opportunity within the context of its unique business environment without 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, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.
Seniority Level Mid‑Senior Level
Employment Type Full‑time
Job Function Finance and Sales
Industries Insurance
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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.
Position Title Compliance Specialist
Location Okemos, MI – Hybrid Position
Position Description Provide support for the day‑to‑day operations and management of the Compliance Program with respect to Delta Dental of Michigan and its affiliates and/or subsidiaries.
Primary Job Responsibilities
Implement initiatives to raise awareness of Company’s Compliance Program including planning, developing and conducting education and training activities related to compliance.
Develop training materials, implement training calendar, monitor and audit employee training records.
Monitor and evaluate documents to determine the relevance of regulatory updates that may affect member materials. Monitor document revision processes, ensuring changes are implemented from request through approval by internal and external parties and verifying accuracy of final production. Provide consistent updates to management and stakeholders on the status of implementation and highlight any risks related to timely and accurate implementation.
Manage and maintain a document repository of member and provider documents, ensuring that forms are consistent with company standards and legal, contractual and regulatory requirements.
Work with internal and external stakeholders to ensure work is prioritized and implemented by required deadlines.
Serve as a liaison for the compliance department, collaborating with key departments to confirm policies and procedures are developed and implemented to ensure compliance with applicable contract provisions, rules and regulations, including the assessment, interpretation and drafting of policy, procedure or job aids.
Advise organization and support Compliance Officer in communicating regulatory changes and implementation of compliance strategies to meet them.
Facilitate and manage coordination between compliance department and operations on new compliance efforts and initiatives.
Play a key role in the annual compliance risk assessment and collaborate to ensure proper auditing is conducted and management of identified risks is appropriate.
Maintain and analyze company’s monitored compliance efforts and identify and assess gaps.
Coordinate various committees and task forces related to company’s compliance, including management of assignments.
Facilitate and coordinate all aspects of any Medicare Advantage, Medicaid or Affordable Care Act audit, request, or inquiry by collecting, reviewing, analyzing and verifying all requested materials prior to submission, including any collaboration with the applicable operational subject matter expert required as a result of the request.
Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
Minimum Requirements Position requires a bachelor’s degree in business administration, health administration, public health/public policy or a related field and three years of compliance experience, preferably in the health insurance industry, or five years’ experience related to auditing, quality monitoring, risk management, or operations. Compliance experience within the Medicare or Medicaid industry preferred. A compliance certification is preferred. Will accept any suitable combination of education, training, or experience.
Position requires the capability to process substantial amounts of detailed information with a high degree of accuracy; demonstrated strong analytical skills, ability to efficiently manage multiple projects and effectively analyze data to develop alternative solutions; excellent interpersonal, verbal, and written communication skills; strong attention to detail and adaptability to shifting priorities and deadlines; strong organizational skills and proficiency in handling competing demands; and the ability to work independently and collaboratively within a fast‑paced team environment.
The company will provide equal employment and advancement opportunity within the context of its unique business environment without 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, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.
Seniority Level Mid‑Senior Level
Employment Type Full‑time
Job Function Finance and Sales
Industries Insurance
#J-18808-Ljbffr