Program Integrity Data Researcher & Analytics

Delta Dental of Michigan

United States

Hybrid

USD 75,000 - 110,000

Full time

9 days ago

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Job summary

Delta Dental of Michigan, Ohio, and Indiana is seeking a Professional Review Data Researcher in Okemos, MI. This hybrid role focuses on transforming raw data into actionable information to support the Professional Review program integrity initiatives throughout the organization.

You will design analytics, validate models, produce dashboards, and perform provider research to identify trends and potential fraud.

Qualifications

Bachelor's degree in computer science, information systems, business administration or a related field required.
Three years of experience performing data analytics in a business setting.
Ability to use data extraction and analysis tools and to communicate findings clearly.

Responsibilities

Designs, develops, validates, and deploys data-driven analytics, predictive models, reporting solutions, and end-to-end analytical research to support Professional Review program integrity initiatives.
Investigates referrals, performs provider research and preliminary reviews, analyzes billing, utilization, and treatment patterns to identify outliers and trends.
Develops recommendations regarding provider placement on or removal from Focused Review; maintains documentation and communications.
Creates, maintains dashboards, databases, reports, analytic tools, and automated workflows for oversight and decision-making.
Collects, cleanses, validates, organizes, and resolves data issues to support analysis-ready data.