Remote Special Investigations Auditor (Fraud & Compliance)

Delta Dental of Michigan; Okemos (MI); Remote; USD 70,000 - 110,000; Full time

Job summary

Delta Dental of Michigan seeks a Special Investigations Unit Investigator to research and report on provider and member activities involving questionable conduct related to treatment patterns, claims, and licensing.

The role requires influencing policy, conducting audits and interviews, and preparing formal reports for management and legal review. Michigan residency near Okemos supports occasional in-person work and meetings within a national scope.

Qualifications

• Bachelor’s degree in accounting, business, finance, healthcare administration, information technology, or related field and 3 years auditing experience.
• Advanced knowledge of dental terminology and dental procedure codes; knowledge of ACL, SQL Developer and IBM FAMS.
• Strong verbal and written communication; ability to manage multiple deadlines.
• AHFI, CFE, or CIA designations preferred.

Responsibilities

• Plans, coordinates, prepares, and performs in-depth provider and member audits, researching questionable conduct using data extraction and analysis tools.
• Conducts interviews, requests and preserves evidence, reviews auditee’s treatment and financial records and controls.
• Prepares written communications to auditees and management to ensure compliance with contracts or state licenses.
• Educates providers and members regarding contractual requirements to gain or maintain compliance.
• Assists law enforcement or attorneys in fraud detection, response to subpoenas, and testimony in proceedings.

Skills

Analytical skills

Verbal communication

Written communication

Organizational skills

Education

Bachelor's degree

Tools

Audit Command Language (ACL)

SQL Developer

IBM FAMS (Fraud & Abuse Management System)

Job description

Delta Dental of Michigan seeks a Special Investigations Unit Investigator to research and report on provider and member activities involving questionable conduct related to treatment patterns, claims, and licensing.

The role requires influencing policy, conducting audits and interviews, and preparing formal reports for management and legal review. Michigan residency near Okemos supports occasional in-person work and meetings within a national scope.