Top 36 Claims manager Jobs in East Lansing Mi

Supervisor, Special Investigations Unit Operations
Delta Dental of Michigan —Okemos, MI
- Full-time
- Hybrid work
- 5 years
- Word processing
- Research
- Dental insurance
- Opportunities for advancement
Account Fraud Manager
MSU Federal Credit Union —East Lansing, MI
- $90,000 - $110,000 a year
- Monday to Friday
- Hybrid work
- Computer literacy
- Mid-level
- Office
- Paid parental leave
- Paid holidays
Quick Apply
14d
UMH Sparrow Health System - Manager of Denials, Audits & Appeals
University of Michigan Health Sparrow —Lansing, MI
- Full-time
- Hospital
- HIPAA
- Finance
Senior Manager, Business Consulting - Payment Integrity Center of Excellence
CVS Health —Lansing, MI
- $67,900 - $199,144 a year
- Full-time
- 5 years
- Analysis skills
- Presentation skills
- Health insurance
- Dental insurance
13d
Business Office Manager
Medilodge of Lansing —Lansing, MI
- Skilled nursing facility
- Nursing home
- Mid-level
- Health savings account
- Loan repayment program
Quick Apply
11d
Senior Manager, Medical Economics
CVS Health —Lansing, MI
- $67,900 - $199,144 a year
- Full-time
- 5 years
- SQL
- Bachelor's degree
- Health insurance
- Dental insurance
Lead Director, Stop Loss Relationship Management
CVS Health —Lansing, MI
- $100,000 - $231,540 a year
- Full-time
- Bachelor's degree
- Fair chance
- Experience equivalent to degree accepted
- Health insurance
- Dental insurance
Field Property Claims Adjuster / Restoration Project Manager (Property Claims Experience Required)
Path Placement Recruiting Services —Lansing, MI
- $70,000 - $120,000 a year
- Full-time
- Management
- Mid-level
- Residential
- Paid holidays
- Opportunities for advancement
Quick Apply
6d
Collision Market Manager
Gerber Collision & Glass —Lansing, MI
- $130,000 - $150,000 a year
- Full-time
- Mentoring
- Military encouraged
- Recruiting
- Paid parental leave
- Paid holidays
Quick Apply
Supervisor, Commercial Sales Support
Michigan Farm Bureau —Lansing, MI
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Health insurance
- Dental insurance
8d
Project Manager
John Grace Construction —Lansing, MI
- $60,000 - $75,000 a year
- Full-time
- Construction site
- Mid-level
- Driver's License
- Fuel card
- Paid holidays
Quick Apply
Office Manager
Premier Dentist Partners —Okemos, MI
- $65,000 - $67,000 a year
- Full-time
- Dental office
- HIPAA
- Bachelor's degree
- Commuter assistance
- AD&D insurance
Renewal Specialist - Lead Worker
Emergent Holdings —Lansing, MI
- Full-time
- Management
- Word processing
- Computer literacy
Sr. Manager, AI Lead - Semantic Layer - Remote
CSAA Insurance Services, Inc. —Okemos, MI
- $168,300 - $224,300 a year
- Full-time
- Computer science
- Product management
- US work authorization
- 401(k) matching
9d
Pharmacy Manager
Walgreens —Lansing, MI
- $67.05 - $90.55 an hour
- Full-time
- Bachelor of Science
- Mid-level
- Patient care
- Continuing education credits
Case Manager Registered Nurse (LTSS) - Field MI (Southwest Michigan)
CVS Health —Lansing, MI
- $60,522 - $129,615 a year
- Full-time
- Bilingual
- Nursing
- Microsoft Outlook
- Health insurance
- Dental insurance
Agency Manager - State Farm Agent Team Member
Josh Orler - State Farm Agent —Lansing, MI
- $60,000 - $90,000 a year
- Full-time
- Sales
- Customer service
- Mid-level
- Health insurance
- Paid time off
Quick Apply
10d
Regional Sales Manager
Essentra —Lansing, MI
- Computer literacy
- Windows
- Microsoft Office
- Paid time off
Rehabilitation Case Manager (Community Based)
RehabiliTory Solutions Medical Case Management —Lansing, MI
- Part-time
- Nursing
- Clean driving record
- RN License
- Flexible schedule
Quick Apply
4d
Agency Manager - State Farm Agent Team Member
Steve VanElls - State Farm Agent —Saint Johns, MI
- $65,000 - $85,000 a year
- Full-time
- Sales
- Customer service
- Mid-level
- Paid time off
- Opportunities for advancement
Quick Apply
10d

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Supervisor, Special Investigations Unit Operations

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
Team leadership
Word processing
Spreadsheets
Contract interpretation
Research
Health insurance knowledge
Healthcare billing investigations
Insurance investigations
Presentation preparation
Productivity software
Insurance (Financial sectors)
Healthcare ethical conduct investigations
Technical Proficiency
Data analysis software

Full Job Description

Job Title:

Supervisor, Special Investigations Unit Operations

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 . 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

claims manager jobs in east lansing mi

Supervisor, Special Investigations Unit Operations

Account Fraud Manager

UMH Sparrow Health System - Manager of Denials, Audits & Appeals

Senior Manager, Business Consulting - Payment Integrity Center of Excellence

Business Office Manager

Senior Manager, Medical Economics

Lead Director, Stop Loss Relationship Management

Field Property Claims Adjuster / Restoration Project Manager (Property Claims Experience Required)

Collision Market Manager

Supervisor, Commercial Sales Support

Project Manager

Office Manager

Renewal Specialist - Lead Worker

Sr. Manager, AI Lead - Semantic Layer - Remote

Pharmacy Manager

Case Manager Registered Nurse (LTSS) - Field MI (Southwest Michigan)

Agency Manager - State Farm Agent Team Member

Regional Sales Manager

Rehabilitation Case Manager (Community Based)

Agency Manager - State Farm Agent Team Member

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