Regulatory & Group Exam Analyst

Delta Dental • Alpharetta, GA

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About The Position

This position is responsible for the overall success of assigned external audits initiated by state/federal regulatory agencies, the Delta Dental Plans Association, and group clients (Medicare/Medicaid/Medical Partners and Commercial groups). The role partners with key stakeholders to perform verification of external audit findings and validation/closure of external audit corrective action plans in an effort to anticipate gaps in regulatory or contractual compliance, fines, and sanctions. In addition to being the organization's core advocate throughout the external audit process, other responsibilities include collaborating with internal business partners to ensure responses to external audit requests, inquiries, and findings adequately and comprehensively meet expectations.

Requirements

• 2+ years of experience with a Bachelor's degree
• Excellent communication skills with a customer-centric approach when interacting with stakeholders (internal and external)
• Detail-oriented with strong analytical and problem-solving skills
• Understands process flows and can identify roadblocks and devise solutions to improve processes
• Strong organizational and time management skills, including the ability to prioritize and manage duties to meet goals and deadlines
• Aptitude to learn and develop proficiencies with new concepts, legal requirements, processes, and technology
• Effectively able to adapt to change and be comfortable handling risk and uncertainty
• Ability to maintain confidentiality when exposed to sensitive information
• Knowledge of Microsoft Office programs, i.e. Word, Excel, Outlook etc.
• Strong working knowledge of health insurance (including Medicare/Medicaid) terminology, processing concepts, policies, guidelines, and systems
• Knowledge of governance, risk, and compliance (GRC) tools

Responsibilities

• Serves as the principal point of contact and advocate for the Company for external audits initiated by state or federal regulatory agencies and group clients.
• Leads external audit kick-off and closing meetings with regulatory examiners and group client auditors and ensures the right participants are engaged to help drive the appropriate outcomes.
• Analyzes applicable regulatory mandates and group contract obligations in relation to external audit information requests, collaborates with subject matter experts on interpretation and requirements, and prepares for timely hand-off to business partners.
• Advises and proposes options to internal stakeholders on the development of responses to external audit findings and manages the external submission (ensuring requirements are met) to the regulatory examiner or group client auditor.
• Analyzes proposed external audit findings received from regulatory examiners and group client auditors against the external audit scope, and formalizes communication with internal stakeholders for operational analysis and validation.
• Engages appropriate Legal Affairs and Policy Division resources regarding potential legal and compliance (regulatory and contractual) issues identified or anticipated in external audits.
• Assesses trends in external audit findings and alerts internal stakeholders of potential enforcement and/or liability issues.
• Manages the communication and advocacy of all external audit finding dispute/rebuttal with regulatory examiners and group client auditors.
• Ensures quality documentation for external audits are adequately maintained in the GRC system and that the record is closed upon completion.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees