At Delta Dental, our strategy is only as strong as the people who execute it! We are hiring individuals that are not just right for today but also for our future. We have built a foundation of high-trust by treating all people with dignity, making and keeping commitments, and consistently striving to do the right thing. Our leaders optimistically share future possibilities to inspire and motivate others toward their full potential. We expect our employees to find ways to embrace positive change, be curious and challenge the status quo, and provide solutions to unmet problems. Joining Delta Dental means joining a culture focused on fostering development, building genuine connections, recognizing each other’s strengths and sharing in successes.
The Provider Compliance Analyst is responsible for determining if dentists are meeting or are able to meet the terms of participation in the various provider networks of the enterprise, including financial and reporting requirements. Responsibilities also include involvement with investigating and resolving suspected provider fraud cases.
How you will make an impact:
- Reviews and determines if dentists meet financial and reporting requirements for participation in provider networks.
- Conducts investigations into cases of suspected fraud or misrepresentation involving providers, brokers, clients or enrollees; including researching, analyzing and assisting in resolution of suspected fraud allegations.
- Raises awareness of fraud issues and handles anti-fraud education efforts.
- Provides support in complying with requests from enforcement agencies and assists in special investigations, as needed.
- Performs miscellaneous duties assigned.
What we look for:
- A Bachelor’s degree or equivalent education is preferred, but candidates with proven experience will not be excluded from consideration.
- Criminal Justice degree, preferred.
- A minimum of 3 years related experience, especially experience in claims investigation and/or several years working with dental insurance/dental office claims.
- Ability to clearly present written information and findings, excellent written communication required.
- Ability to communicate concepts.
- Ability to make executive-level presentations.
- Ability to interact well with co-workers and outside contacts.
- Strong organizational/time management and project management skills and multi-tasking abilities.
- Detail orientation and basic problem-solving skills.
- Knowledge of health care industry issues preferred.
- Knowledge of Delta Dental products, policies, claims, eligibility and underwriting guidelines.
- Ability to obtain and maintain sufficient credit to manage related job expenses.
- Must be able to travel, including travel to investigation or examination sites where environment cannot be predicted.
Benefits and perks:
- 12 days starting vacation plus 11 holidays and your birthday off!
- Multiple medical insurance options: 100% paid or low cost premiums
- 100% paid dental insurance
- 100% paid vision insurance
- Onsite gym and/or gym discount and fitness incentive
- Culture of learning: substantial tuition reimbursement to improve your skills
- Career growth: we love promoting from within
- Strong commitment to work/life balance
- Technology allowance
- Social responsibility and volunteer opportunities
At Delta Dental we:
Promote accountability, integrity and collaboration: Our employees are collaborative, self-aware, and ethical. It is our expectation to do the right thing and follow through on commitments.
Foster professional development: Our employees take ownership of developing themselves and others through coaching, mentoring and providing/being open to constructive feedback and identifying learning opportunities.
Value customers and cultivate positive experiences: Our employees take time to build rapport with customers, while anticipating and exceeding their needs to ensure positive outcomes.
If you think this sounds like you, let’s chat. We would love to tell you more!
ABOUT Delta Dental
Delta Dental covers more Americans than any other dental benefits provider. As an employee you’ll take part in our mission to become the trusted health partner by collaborating with our communities and employees to reimagine and deliver new possibilities in an ever-changing environment. Our Enterprise Strategy focuses on pillars of Growth and Diversification, supported by the platforms of Culture and People, Process and Technology. Our employees take pride working for a purpose-driven organization and live our values of Trust, Service, Excellence and Innovation.
We are part of the Delta Dental Plans Association, a network of companies that provides dental coverage to 74 million people in the U.S. Delta Dental of California, Delta Dental of New York, Inc., Delta Dental of Pennsylvania and Delta Dental Insurance Company, together with our affiliate companies, form one of the nation’s largest dental benefits delivery systems, covering 33 million enrollees. All of our companies are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies throughout the country.
Delta Dental provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Delta Dental complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
- Life Insurance
- Medical, Dental and Vision
- Paid Holidays
- Professional Development
- Vacation/paid time off