Remote SIU Investigator – Fraud & Compliance

Delta Dental of Michigan; Okemos (MI); On-site; USD 65,000 - 90,000; Full time

Job summary

Delta Dental of Michigan is seeking an investigator for the Special Investigations Unit. The role centers on researching and reporting on provider and member activities related to treatment patterns, claims, contracts, and licensing compliance.

Applicants should have strong auditing, data analysis, and interviewing skills; familiarity with ACL, SQL Developer, and FAMS is preferred. The team collaborates across internal functions in Okemos, MI.

Qualifications

• Position requires a bachelor’s degree in accounting, business administration, finance, healthcare administration, information technology, or a related field.
• Three years of auditing experience with data analysis tools or in dental/healthcare settings.
• Advanced knowledge of dental terminology and codes; familiarity with data mining tools.

Responsibilities

• Plans, coordinates, prepares, and performs in-depth provider and member audits using data analysis tools.
• Conducts interviews, preserves evidence, and reviews auditee records and contracts.
• Prepares written communications and audit reports for auditees and management to ensure compliance.
• Educates providers and members on contractual requirements to maintain compliance.
• Supports law enforcement or attorneys in fraud detection and testimony preparation.
• Provides recommendations to strengthen system controls and contract agreements.
• Develops training programs for Anti-Fraud activities and maintains affiliate relationships.

Skills

Auditing

Data analysis

Interviews

Education

Bachelor's degree in a relevant field

Tools

ACL

SQL Developer

FAMS

Job description

Delta Dental of Michigan is seeking an investigator for the Special Investigations Unit. The role centers on researching and reporting on provider and member activities related to treatment patterns, claims, contracts, and licensing compliance.

Applicants should have strong auditing, data analysis, and interviewing skills; familiarity with ACL, SQL Developer, and FAMS is preferred. The team collaborates across internal functions in Okemos, MI.