Remote Government Programs Appeals Research Specialist

Delta Dental Plan of Indiana, Inc.; Okemos (MI); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Benefits package

Volunteer time off

Tuition reimbursement

Health coach / wellness

Job summary

Delta Dental of Michigan, Ohio, and Indiana is seeking candidates for Government Programs Appeals and Grievances Research Specialist roles. The positions involve resolving dental benefit determinations, analyzing provider and subscriber referrals, and supporting fraud and abuse initiatives.

This is a remote-friendly opportunity within Michigan with team collaboration and training sessions. Ideal applicants hold an associate's degree with four years of relevant experience in dental terminology,

Qualifications

• Associate's degree in accounting, business administration, criminal justice, dental assisting or hygiene, or a related field with four years of relevant experience.
• Knowledge of dental terminology, dental procedure codes, or dental office billing and record-keeping practices.
• Experience supporting an anti-fraud/abuse program preferred.
• Strong verbal and written communication, analytical, and independent working skills.

Responsibilities

• Researches, analyzes, and resolves government programs cases involving compliance issues such as balance billing and quality of care.
• Performs data analysis, records audit, and interviews with external customers.
• Collaborates with Legal, Compliance, and Customer Service to meet government program requirements.
• Maintains case documentation and coordinates data for audits and hearings.

Skills

Verbal communication

Written communication

Analytical skills

Time management

Education

Associate's degree

Tools

Word processing

Spreadsheet

Database applications

Job description

Delta Dental of Michigan, Ohio, and Indiana is seeking candidates for Government Programs Appeals and Grievances Research Specialist roles. The positions involve resolving dental benefit determinations, analyzing provider and subscriber referrals, and supporting fraud and abuse initiatives.

This is a remote-friendly opportunity within Michigan with team collaboration and training sessions. Ideal applicants hold an associate's degree with four years of relevant experience in dental terminology,