Remote Special Investigations Auditor – Fraud & Compliance

Delta Dental Plan of Michigan; United States; A distancia; USD 65.000 - 90.000; Jornada completa

Descripción de la vacante

Delta Dental Plan of Michigan invites applications for a Special Investigations Unit Investigator. The role focuses on audits of providers and members to identify questionable conduct, using data extraction tools and thorough records reviews.

You will interview, gather evidence, and prepare formal reports while ensuring compliance with contracts and laws. The position emphasizes education of providers and collaboration with law enforcement when needed, with opportunities for anti-fraud training

Formación

• Bachelor's degree in a related field is required; combination of education/training acceptable.
• Advanced knowledge of dental terminology and codes; strong data mining tools.
• Experience with ACL, SQL Developer and IBM FAMS; strong communication and problem-solving skills.

Responsabilidades

• Plan, coordinate, prepare and perform in-depth provider and member audits; research questionable conduct.
• Conduct interviews; request and preserve evidence; review auditee records and contracts.
• Prepare written communications and audit reports for auditee and management; ensure compliance.
• Educate providers/members on contractual requirements to maintain compliance.
• Assist law enforcement or attorneys in detecting and prosecuting fraud; respond to subpoenas; testify as needed.
• Recommend improvements to systems and contracts to prevent aberrant behavior.
• Develop anti-fraud training programs for corporate staff.
• Support relationships with Delta Dental affiliates; perform other related duties.

Conocimientos

Auditing

Analytical skills

Verbal & written communication

Educación

Bachelor's degree in accounting / business / finance / healthcare admin / IT

AHFI / CFE / CIA designation (preferred)

Herramientas

Audit Command Language (ACL)

SQL Developer

IBM FAMS

Descripción del empleo

Delta Dental Plan of Michigan invites applications for a Special Investigations Unit Investigator. The role focuses on audits of providers and members to identify questionable conduct, using data extraction tools and thorough records reviews.

You will interview, gather evidence, and prepare formal reports while ensuring compliance with contracts and laws. The position emphasizes education of providers and collaboration with law enforcement when needed, with opportunities for anti-fraud training