Supervisor, Special Investigations Unit Operations

Delta Dental Plan of Michigan, Inc.; Okemos (MI); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401(k) savings plans

Tuition reimbursement

Job summary

Delta Dental Plan of Michigan, Inc. is seeking a Supervisor for its Focused Review team in Okemos, MI. This hybrid position involves overseeing auditing and investigation processes within the dental insurance sector, ensuring data integrity and operational compliance.

Applicants must have a Bachelor's degree and five years of relevant experience, preferably with leadership exposure. The role demands strong analytical skills, effective team management, and conflicts resolution abilities.

A comprehensive benefits package is offered, including medical coverage, 401(k), and professional development assistance.

Qualifications

• 5 years of experience auditing or analyzing data in the insurance industry.
• Advanced knowledge of dental terminology and insurance products.
• Strong ability to lead multiple teams and manage competing deadlines.

Responsibilities

• Supervise Focused Review SIU teams and ensure compliance with goals.
• Support recruitment and development of staff.
• Oversee data research and analytics for audits.

Skills

Data analysis

Leadership

Communication

Organizational skills

Analytical thinking

Education

Bachelor's degree in business administration or related field

Tools

SQL

ACL

Tableau

Job description

Job Title

Supervisor, Focused Review

Location

Okemos, MI (Hybrid Position)

Job Summary

At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy, and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation. At Delta Dental, we celebrate our All In culture.

Position Description

Plans, organizes, and supervises the administrative and technical functions of the Focused Review Special Investigation Unit (SIU) teams, including oversight of data research and review, and audit and investigation activities. Ensures all team operations align with corporate and departmental goals and objectives, maintains compliance with applicable standards and policies, and supports continuous improvement in Focused Review processes.

Primary Job Responsibilities

• Supervises and monitors the daily administrative and technical functions of the Focused Review SIU teams, data research and review, and audit and investigation activities to ensure efficient, compliant operations that support departmental and corporate goals and objectives.
• Supports staff recruitment, onboarding, and development by assisting with interviewing, training, mentoring, and evaluating team members to promote accountability and achievement of individual and team objectives.
• Oversees staff engaged in data research, report development, and analytics, serving as a resource for audit and research questions and providing guidance to internal and external stakeholders on reporting issues, provider agreements, processing policies, client contracts, and regulatory compliance for both commercial and government programs.
• Implements and enforces policies, procedures, and standards for audits and investigations, and assists in preparing departmental reports and analyzing business processes to ensure compliance with regulatory requirements for both commercial and government programs.
• Facilitates communication with law enforcement and legal representatives by supporting the preparation of documentation and responses to subpoenas, and assisting with administrative or judicial proceedings related to fraud, waste, and abuse.
• Builds and maintains collaborative relationships with business partners to provide operational support, clarify requirements, and promote effective use of SIU services and solutions.
• Acts as a liaison for staff and internal departments, providing expertise and interpretation of dental policies, procedure codes, and processing guidelines related to claims adjudication, fraud, waste, and abuse activities.
• Assists in developing and implementing departmental strategies, goals, and objectives to support continuous improvement and operational excellence.
• Supports budget monitoring and resource allocation for the Focused Review SIU teams as directed by management.
• Performs other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

Minimum Requirements and Qualifications

Position requires a bachelor's degree in business administration or a related field and five years of experience auditing or analyzing data in the insurance industry. Previous leadership experience is preferred, as well as experience with claims processing software or analyzing group or provider contracts in the insurance industry. Will accept any suitable combination of education, training, or experience. Position requires advanced knowledge of the insurance industry, dental terminology, procedures, and dental insurance products; ability to use data extraction and analytic tools, word processing, spreadsheet, and presentation software; strong verbal and written communication skills; strong organizational and analytical skills; the ability to lead multiple teams; the ability to interpret contract language related to fraud, waste, and abuse and claims processing; the ability to manage multiple assignments with competing deadlines; and the ability to resolve complex problems using independent judgment. Experience with SQL, ACL, and Tableau preferred. CFE, CIA, AHFI also preferred.

EEO Statement

The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance. Delta Dental of Michigan, Ohio, and Indiana has been a dental benefits leader for more than 60 years, and today with its affiliates, we are one of the largest dental plan administrators in the country. We celebrate diverse thought and foster a culture where employees go All In – for the company, themselves, their colleagues, and their communities. Delta Dental is an Equal Opportunity Employer.

Benefits

Employees are offered a comprehensive benefits package that includes medical, dental, and vision coverage, short- and long-term disability, life insurance, 401(k) savings plans, flexible spending accounts, and tuition reimbursement or educational assistance. Employees are also eligible for annual incentive compensation based on annual business goals. Additionally, employees receive eight hours of paid volunteer time each year, access to an on-staff health coach and personal trainer, plus many other perks.