Top 176862 Advanced Resources Jobs

Supervisor, Focused Review
Delta Dental of Michigan —Okemos, MI
- Full-time
- Hybrid work
- 5 years
- Word processing
- Research
- Dental insurance
- Opportunities for advancement
Organizational Psychologist
Central Intelligence Agency —Washington, DC
- $179,891 - $288,000 a year
- Full-time
- 5 years
- Doctor of Philosophy
- Travel
- Health insurance
- Dental insurance
Human Resources Consultant
GTM Payroll Services Inc —Clifton Park, NY
- $34 - $38 an hour
- Part-time
- Hybrid work
- 5 years
- Analysis skills
- Bachelor's degree
- Health insurance
- Dental insurance
Quick Apply
Human Resources Consultant (6-12 Month Contract)
Kanto Corporation —Portland, OR
- $80,000 - $90,000 a year
- Contract
- Hybrid work
- Bachelor of Science
- Research
- Mid-level
- Flexible schedule
Quick Apply
8d
Principal Telecom Solution Architect, Technology & Digital, FT,8A-4:30P
Baptist Health South Florida —Coral Gables, FL
- $159,575.01 - $207,447.51 a year
- Full-time
- Computer Science
- Doctor of Philosophy
- Team management
- Wellness program
- Health insurance
Case Analyst
YA Group —Remote
- Full-time
- Remote
- Writing skills
- Mid-level
- High school diploma or GED
- Paid holidays
- Health insurance
Records Management Specialist - Federal
A P Ventures LLC —Remote
- From $100,000 a year
- Remote
- Background check
- PMP
- Mid-level
Quick Apply
Access Management Coordinator
Halliday, Watkins & Mann, P.C. —Remote
- $21 - $24 an hour
- Full-time
- Remote
- Mid-level
- Organizational skills
- Communication skills
- 401(k)
- Flexible schedule
Quick Apply
3d
Clinic Expansions Project Manager
VIP Medical Group —Remote
- $70,000 - $80,000 a year
- Full-time
- Remote
- Google Workspace
- Clinic experience
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
10d
Grants Project Coordinator & Data Processing Specialist, Associate
LCG, Inc. —Rockville, MD
- $27.64 - $34.01 an hour
- Remote
- Microsoft Outlook
- Mid-level
- Continuous improvement
- Paid holidays
- Disability insurance
Quick Apply
Project Coordinator - Atlanta, GA (Hybrid) = Contract Position
INFO ORIGIN INC —Atlanta, GA
- $35 - $40 an hour
- Contract
- Remote
- Microsoft Outlook
- Mid-level
- Organizational skills
Quick Apply
Entry - Level Talent Acquisition Specialist
American Advanced Materials —New York, NY
- $31.32 - $37.92 an hour
- Part-time
- Hybrid work
- Bachelor's degree
- Business
- Communication skills
- Health insurance
- 401(k)
Quick Apply
8d
Human Resources Specialist
PACCAR —Renton, WA
- $62,000 - $85,030 a year
- Research
- Office
- Analysis skills
- Health savings account
- AD&D insurance
Human Resources Admin - Contract
TSMC —Phoenix, AZ
- Full-time
- English
- Office
- Travel
Quick Apply
Information Security Project Manager
Advanced Image Inc. —Remote
- $93,956.20 - $140,000.00 a year
- Full-time
- Remote
- 5 years
- Bachelor of Science
- Mid-level
Quick Apply
9d
Human Resources Specialist
Global Lending Services —Greenville, SC
- Full-time
- Hybrid work
- Research
- Bachelor's degree
- US work authorization
- Paid holidays
- Disability insurance
Quick Apply
Temporary HR Generalist (6 Months)
Curinos Inc —New York, NY
- $60 - $65 an hour
- Full-time
- Microsoft Excel
- Mid-level
- 3 years
- Health insurance
- Parental leave
Quick Apply
Health Communications Specialist
Vitek Consulting —Atlanta, GA
- Marketing
- 5 years
- Master's degree
- Health insurance
- Dental insurance
Project Manager
CBX Solutions —Remote
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Construction site
- Health insurance
- Dental insurance
Quick Apply
10d
Human Resources Representative
Novant Health Urgent Cares LLC —Columbia, SC
- Full-time
- Microsoft Excel
- Urgent Care
- Research
- Continuing education credits
- 403(b) matching
Quick Apply

I want to receive the latest job alert for Advanced Resources

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

Advanced Resources jobs near

Human Resources Specialist jobs in Greenville, SC

Human Resources Specialist jobs in Portland, OR

Access Manager jobs in Remote

Project Coordinator jobs in Atlanta, GA

Project Manager jobs in Remote

Project Coordinator jobs in Rockville, MD

Records Specialist jobs in Columbia, MD

Information Security Manager jobs in Remote

Clinical Project Manager jobs in Remote

Human Resources Specialist jobs in Phoenix, AZ

Psychologist jobs in Washington, DC

Human Resources Generalist jobs in New York, NY

Human Resources Specialist jobs in Palos Park, IL

Qualified Behavioral Health Specialist jobs in Ohio

Human Resource Internship jobs in Seattle, WA

Human Resources Specialist jobs in Elk Grove, CA

Human Resources Specialist jobs in Rancho Cucamonga, CA

Human Resources Specialist jobs in California

Human Resources Specialist jobs in Tolleson, AZ

Human Resources Specialist jobs in Clermont, FL

Supervisor, Focused Review

Delta Dental of Michigan -
Okemos, MI

Apply Now

Job Details

Full-time

Benefits

Dental insurance
Opportunities for advancement

Qualifications

Contract documentation review
Healthcare financial misconduct investigations
Contract review
Word processing
Spreadsheets
Contract interpretation
Research
Internal investigations
Health insurance knowledge
Healthcare billing investigations
Insurance investigations
Presentation preparation
Productivity software
Insurance (Financial sectors)
Technical Proficiency
Data analysis software

Full Job Description

Job Title:

Supervisor, Focused Review

Number of Positions:

Location:

Okemos, MI

Location Specifics:

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. It’s a mindset, feeling and attitude we wrap around all that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community.

Position Description:

Plans, organizes, and supervises the Provider Auditor Focused Review Special Investigation Unit (SIU) , including oversight of data research and review, and audit and investigation activities. E nsures 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.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

#LI-Hybrid

Minimum Requirements:

Position requires a bachelor’s degree in business administration , criminal justice, or related field a nd five years of experience conducting investigations, audit s, or complex data analy sis within the insurance industry. Previous leadership experience is preferred , as well as experience reviewing claims activity, provider behavior, or group contract compliance. Will accept any suitable combination of education, training, or experience.

Position requires advanced knowledge of the insurance industry operations; strong investigative skills related to fraud, waste, and abuse; proficiency with analytic al tools, word processing, spreadsheet, and presentation software skills; strong verbal and written communication skills, strong organizational and analytical skills; the ability to lead investigative teams ; the ability to interpret contract language and identify indicators of fraudulent activity ; the ability to manage multiple assignments with competing deadlines; and the ability to resolve complex problems using independent judgment. Professional certifications such as CFE, CIA, AHFI are preferred .

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.

Apply Now

Refine Your Search

Advanced Resources jobs

Supervisor, Focused Review

Organizational Psychologist

Human Resources Consultant

Human Resources Consultant (6-12 Month Contract)

Principal Telecom Solution Architect, Technology & Digital, FT,8A-4:30P

Case Analyst

Records Management Specialist - Federal

Access Management Coordinator

Clinic Expansions Project Manager

Grants Project Coordinator & Data Processing Specialist, Associate

Project Coordinator - Atlanta, GA (Hybrid) = Contract Position

Entry - Level Talent Acquisition Specialist

Human Resources Specialist

Human Resources Admin - Contract

Information Security Project Manager

Human Resources Specialist

Temporary HR Generalist (6 Months)

Health Communications Specialist

Project Manager

Human Resources Representative

I want to receive the latest job alert for Advanced Resources

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected