Remote Government Programs Appeals Research Specialist

Delta Dental of Michigan; United States; Remote; USD 60,000 - 75,000; Full time

Job summary

Delta Dental of Michigan, Ohio, and Indiana seeks a Government Programs Appeals and Grievances Research Specialist in Okemos, MI, with a fully remote option. The role focuses on resolving dental benefit determinations, provider referrals, and fraud/abuse program support.

Candidates must reside in Michigan near Okemos for meetings and training. A related associate degree with four years’ experience and strong analytical, written, and verbal skills are required.

Qualifications

• Associate degree plus four years of experience in a role with dental terminology, codes, or billing within a provider office or insurance context.
• Experience supporting anti-fraud/abuse programs is preferred.
• Strong analytical, verbal and written communication skills required.

Responsibilities

• Researches, analyzes, and resolves government programs cases involving compliance issues and appeals.
• Collaborates with Legal/Compliance and Customer Service to meet requirements and deadlines.
• Reviews cases for clients handling their own appeals; assists with adjustments and record requests.
• Communicates with internal and external customers to obtain information and relay actions taken.
• Prepares dental claims for determinations and maintains claims records; coordinates adjustments on complex claims.
• Maintains thorough case documentation in the appeal and grievance system.
• Coordinates data for audits and hearings and for use by legal counsel.

Skills

Analytical skills

Verbal communication

Written communication

Independent work

Team collaboration

Education

Associate degree

Dental terminology knowledge

Job description

Delta Dental of Michigan, Ohio, and Indiana seeks a Government Programs Appeals and Grievances Research Specialist in Okemos, MI, with a fully remote option. The role focuses on resolving dental benefit determinations, provider referrals, and fraud/abuse program support.

Candidates must reside in Michigan near Okemos for meetings and training. A related associate degree with four years’ experience and strong analytical, written, and verbal skills are required.