Clinical Operations Program Integrity Analyst

Job Title:

Clinical Operations Program Integrity Analyst

Number of Positions:

1

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:

Designs, develops and deploys data-driven analytics and predictive models to support Government Programs Clinical Operations in strengthening program integrity and improving reporting and decision-making.

Primary Job Responsibilities:

• Designs, develops, validates, and deploys predictive models and other advanced analytics using appropriate analytical techniques and software tools.
• Administers end-to-end analytical research for Government Programs Clinical Operations initiatives, including defining objectives, selecting and evaluating data, determining analytical approaches and methods, performing analysis and testing, conducting quality assurance, and interpreting results.
• Serves as a consultant to internal and external customers on reporting, analytics, and research questions, translating business needs into clear deliverables and actionable insights.
• Partners with the Government Programs Clinical Operations team to review and analyze provider billing and treatment patterns, identify potential outliers or areas of concern, and develop monitoring action plans.
• Develops and deploys needs assessments, case studies, and related analytic deliverables to support monitoring activities and inform operational decisions.
• Plans, coordinates, and performs provider research for preliminary investigative reviews, including analysis to identify outlying data, substantiate referrals, and make recommendations on actions needed.
• Develops, maintains, and enhances departmental dashboards and databases to store, organize, and present data, and ensures data availability and usability for reporting and analysis.
• Troubleshoots and resolves system, data, and database issues and supports data quality, integrity, and consistent definitions across sources.
• Collects and curates data by analyzing business results and by developing, initiating, and managing new information studies as needed.
• Transforms, cleans, and converts data into analysis-ready formats and creates repeatable processes that improve efficiency and reproducibility.
• Builds and maintains tools and scripts to automate data collection and recurring analytical workflows.

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 computer science, information systems, business administration or a related field and three years of experience performing data analytics in a business setting. Will accept any suitable combination or education, training, or experience.
 
Position requires general knowledge of insurance business, the claims processing system and other business applications; the ability to use data extraction and analysis tools, such as Microsoft Office, Oracle Discoverer, SQL, Tableau, and ACL; strong verbal and written communication skills; strong analytical skills; the ability to convey written and oral summaries of data analysis to clients, team members, and business leaders; and the ability to resolve problems using independent judgment.

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.