Insurance Fraud Investigator

Delta Dental Ins

4.8

Mechanicsburg, PA

Why you should apply for a job to Delta Dental Ins:

  • Ranked as one of the Best Companies for Women in 2022

  • 4.8/5 in overall job satisfaction

  • 4.7/5 in supportive management

  • 98% say women are treated fairly and equally to men

  • 98% would recommend this company to other women

  • 96% say the CEO supports gender diversity

  • Ratings are based on anonymous reviews by Fairygodboss members.
  • We partner with Progyny & Kaiser to offer employees fertility benefits

  • [email protected] is an inclusion community for women-identifying employees, as well as allies

  • Our 401(k) plan provides employees with a variety of investment options to help build, diversify and maintain savings over time

  • #1024

    Position summary

    JOB DESCRIPTION

    The Network Oversight and Compliance (NOC) Analyst acts to safeguard dental benefit programs from fraud, waste, and abuse by assessing provider ability and actions to meet the terms of participation in provider networks and state/federal requirements. The Analyst performs audits and reviews of dental records, assists in special investigations, and provides support in fulfilling requests from various enforcement agencies.

    RESPONSIBILITIES

    • Conduct desk audits and/or onsite examinations of dental offices to determine if providers are meeting or have the ability to meet the terms of provider network participation and state/federal regulations.

    • Maintain audit records, reports, letters, exhibits of findings, and other documentation as related to items such as proposed refunds, disciplinary actions, and educational outreach.

    • Conduct investigations into cases of suspected fraud, waste, and abuse involving providers, brokers, clients or enrollees; investigations may involve, but are not limited to, violations of the terms of participation, group contracts, or government regulations.

    • Research, coordinate, and assist in the resolution of allegations regarding suspected fraud, waste, and abuse.

    • Partner with senior analysts to handle escalated or highly complex cases as needed.

    • Assist in response to inquiries from enforcement agencies by conducting research, providing requested documentation, and collecting evidence in support of such activities or in preparation for referring cases for criminal prosecution.

    • Potential for travel to assist in onsite examinations.

    • Serve as a subject area expert and field questions from various sources, including other divisions.

    QUALIFICATIONS

    • 2+ w/Bachelor's degree

    • 2+ years of insurance claims investigation experience or 4 years of dental insurance, insurance claims/coding, or dental office experience, or a combination to total 4 years' experience may be substituted for above requirements.

    • Ability to build trust through organizational savvy and interpersonal skills, allowing for ease of collaboration and communication.

    • Aptitude to proactively collect and interpret facts, identify and define vulnerabilities, and initiate opportunities and solutions.

    • Ability to learn through embracing challenges, persisting in the face of setbacks, and processing constructive feedback.

    • Strong organizational and prioritization skill sets that enable one to set and meet deadlines/time frames.

    • Self-motivated and takes initiative. Must be able to work with minimal supervision.

    • Proficiency with the Microsoft Office Suite, including Word, Excel, Outlook, Teams, etc.

    Base Pay Information

    The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity. $52,000 - $104,300

    ADDITIONAL INFORMATION

    Rewards to make you smile! We don't just want to make our customers happy - we want to give our employees a reason to smile, too. Delta Dental's comprehensive benefits package includes:

    • Generous paid time off plus 12 holidays and your birthday off!

    • Low-cost premium medical insurance options

    • 100% paid dental and vision insurance

    • Generous 401(k) matching and flat contribution

    • Social responsibility and volunteer opportunities, including 16 paid volunteer hours annually

    • Employee LiveWell program, focusing on overall employee well-being

    • Fertility and diabetes benefits

    • Employee discount program: AT&T/Verizon, entertainment, travel, and more!

    • Culture of learning: career development and tuition reimbursement

    • Career growth: we love promoting from within

    Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

    Please note, Delta Dental will not sponsor applicants for work visas for this position.

    #LI-Hybrid

    ABOUT THE TEAM

    At Delta Dental, our success is only as strong as the people who execute it! We take enormous pride in being the nation's most recognized and widely-used provider of dental insurance - and we've come this far by living our core values of innovation, excellence, service and trust. Our vision is to motivate and empower every employee so that we're all inspired to take exceptional care of our customers, providers and ourselves. We believe in integrity, accountability, collaboration, and giving every employee equitable opportunity for their voice to be heard and development to be fostered.

    If you're excited about the prospect of transforming the future of health care and growing in your career, join our smile revolution!

    To see some of the smiling faces behind Delta Dental and to learn more about what our values and culture look like in action, connect with us on social media: Delta Dental Ins. on Facebook and Instagram, #LifeatDDins on Facebook and Instagram, Delta Dental Ins. on Twitter and Delta Dental Ins. on LinkedIn.

    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 is an equal opportunity employer. We are committed to building and maintaining a diverse and inclusive workplace for all employees. Applicants will not be discriminated against because of race, color, religion, creed, national origin, ancestry, citizenship status, sex (including pregnancy), sexual orientation, gender or identity expression, age, disability, marital status, medical status, veteran status or any other status protected under federal, state, or local law. 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.

    Unfortunately, our Delta Dental Enterprise is unable to hire individuals residing in Alaska, North Dakota, Nebraska, Hawaii, Oklahoma, Vermont, Maine, West Virginia, New Hampshire, Wyoming, Puerto Rico or other US Territories at this time.

    Proof of eligibility to work in the United States must be provided if selected for hire.

    *Delta Dental includes: Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, and Delta Dental of New York

    If You Are A Current Employee Click Here To Apply

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    What are Delta Dental Ins perks and benefits

    Fertility

    Backup child care

    Care-taking PTO

    Elder care

    Coaching

    About the company

    Industry: Insurance: Health

    As a Delta Dental employee, you’ll help us build a more inclusive workplace, collaborate with our communities and re-imagine what we can do in an ever-changing environment. When you join Delta Dental, you’re joining a culture focused on fostering personal and professional development, building genuine connections and recognizing all our strengths. 

    Through our ...

    Why you should apply for a job to Delta Dental Ins:

  • Ranked as one of the Best Companies for Women in 2022

  • 4.8/5 in overall job satisfaction

  • 4.7/5 in supportive management

  • 98% say women are treated fairly and equally to men

  • 98% would recommend this company to other women

  • 96% say the CEO supports gender diversity

  • Ratings are based on anonymous reviews by Fairygodboss members.
  • We partner with Progyny & Kaiser to offer employees fertility benefits

  • [email protected] is an inclusion community for women-identifying employees, as well as allies

  • Our 401(k) plan provides employees with a variety of investment options to help build, diversify and maintain savings over time