Government Programs Claims Analyst - Metrics and Monitoring

Delta Dental of Michigan • Okemos, MI

1d • Hybrid

About The Position

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: Analyzes, monitors, and reports on claims processing using advanced data analytics and visualization techniques as well as identifies trends, risks, and improvement opportunities.

Requirements

• Position requires a bachelor’s degree in health administration, business, data analytics, finance or related field and three years of experience analyzing or resolving business, system or process issues within the healthcare or insurance industry.
• Will accept any suitable combination of education, training, or experience.
• Position requires experience with data visualization tools, specifically Power BI and/or Tableau, SQL or similar querying tools, and proficiency in Excel and working with large datasets; strong analytical skills; strong attention to detail and data accuracy; the ability to work independently and as part of a team; the ability to manage multiple assignments with competing deadlines; effective verbal and written communication skills; and the ability to resolve complex problems using independent judgement.

Nice To Haves

• Previous experience in the administration of Medicare and/or Medicaid programs is preferred.

Responsibilities

• Develops, maintains, and enhances dashboards and reports using Power BI, Tableau, or similar data visualization tools to monitor claims performance and operational metrics.
• Analyzes claims data to identify trends, anomalies, root causes, and performance gaps related to timeliness, accuracy, cost, utilization, and compliance.
• Monitors key performance indicators and service level agreements for claims operations, escalating risks and issues as appropriate.
• Collaborates and communicates closely across departments to ensure reporting data accuracy and consistency.
• Supports internal and external reporting requirements, including new client implementations and support of account management.
• Ensures data integrity, accuracy, and consistency across reports and dashboards.
• Automates recurring reports and improves reporting efficiency where possible.
• Contributes to continuous improvement initiatives related to claims processing and data analytics.
• Responsible for running basic SQL queries and working with Government Programs Reporting for more complex queries.
• Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level