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Deloitte Program Integrity – Manager (Dental Claims Investigator) in McLean, Virginia

Are you an analytical, data-drivenprofessional? Are you interested in a role that uses leading edge analytics andoffers an opportunity to provide front line support to solve our clients mostchallenging problems? If so, the Forensic Analytics practice within DeloitteTransactions and Business Analytics LLP (DTBA) is the place for you!

Forensic Analytics is a fast-growth practicewithin Deloitte Risk and Financial Advisory that centers around several of thehottest areas of business today analytics, forensic analysis, and litigationsupport and the specialized skills that make careers in these areas bothfascinating and in high-demand. Our Analytics team makes extensive use of data,statistical and quantitative analysis, rules-based methods, and explanatory andpredictive modeling to bring insights to client issues in the forensic andtransaction domains. We work with specialists in many areas, and we apply oursolutions to a wide range of highly interesting and complex corporatechallenges, such as forensic investigations, sales fraud, anti-corruptioncompliance, restructuring, safety and quality, enterprise fraud and misusemanagement to explain what has occurred in the past and to support informeddecision making for the future. Our work increasingly employs specializedcompetencies, such as advanced analytics, visualization, and geospatialtechniques.

Work you ll do

  • Provide domain experience in review of dental plan policy

  • Guide the development and review of new dental rules

  • Conduct dental chart reviews

  • Maintain a deep, working understanding of ADA dental procedures codes and standard dental claim processing policies as defined by our dental client

  • Conducting investigations into dental cases to identify potential fraud, waste, abuse, or improper payment.

  • Performing and interpreting dental billing patterns to identify potential fraud, waste, abuse, or improper payment.

  • Interpreting dental policy to validate proper payment was made.

  • Serve as a Subject Matter Expert , adding interpretive value to data presented or experienced insight into a functional process or issue

  • Preparing and presenting complex written and verbal materials (reports, findings and presentations)

  • Contributing to a strong client relationship through interactions with client personnel on investigation-related issues.

  • Supervise, lead, and train junior staff in the aforementioned activities and career counseling

  • Responsible for managing solutions, delegating resources, and helping to ensure quality assurance principles are met across projects and deliverables

  • Assuming responsibility for small components of engagements. May have greater role on small engagements.

  • Maintain technical knowledge within industry and service line and leverage deep subject matter knowledge on engagements

  • Contribute to new business proposals and client pursuits and lead proposal development

  • Manage own personal and professional development; seek opportunities for professional growth and expansion of consulting skills and experience

  • Network and negotiate to identify and sell potential new services or expand existing engagements by leveraging client relationships

  • Generate marketplace eminence through the creation of intellectual property across a host of mediums including but not limited to: articles, whitepapers, webcasts and other audio visual presentations

The Team

As the regulatory landscape continues to shift and grow incomplexity, companies are facing unprecedented compliance challenges and closeregulatory scrutiny. We provide solutions in health care compliance, risk andtechnology-driven managed services. Managing your financial, operational, andreputational risk to allow you to focus on what matters most - the patient,innovation, and the greater health care marketplace.

Qualifications

  • Bachelor's degree in Accounting, Business, Finance or other Business-related field

  • 5 years of Forensic, Investigative, and/or Discovery industry related experience

  • 2 years in a technical or functional lead role

  • Experience mentoring and coaching others

  • Experience reviewing dental claims, charts, and x-rays

  • Experience reviewing and interpreting dental policy

  • Extensive knowledge of dental procedure codes, dental claims processing, and provider relations, as well as the ability to understand the cascading impact of claims processing policy changes on key performance indicators, claim costs, and overall financial health of the organization

  • Proven leadership skills demonstrating strong judgment, problem-solving, and decision-making abilities

  • Experience managing senior-level client relationships

  • Experience presenting to clients or other decision makers to present and sell ideas to various audiences (technical and non-technical)

  • Pre-sales, proposal, and RFP experience

  • Must be able to obtain and maintain required clearance for this role

Must be legally authorized to workin the United States without the need for employer sponsorship, now or at anytime in the future.

Preferred

  • Previous experience as a dental adjudicator

Benefits

At Deloitte, we know that great people make a greatorganization. We value our people and offer employees a broad range ofbenefits. Learn more about what working at Deloitte can mean foryou. at http://www2.deloitte.com/us/en/pages/careers/articles/life-at-deloitte-benefits-and-rewards.html

Deloitte s culture

Our positive and supportive culture encourages our people todo their best work every day. We celebrate individuals by recognizing theiruniqueness and offering them the flexibility to make daily choices that canhelp them to be healthy, centered, confident, and aware. We offerwell-being programs and are continuously looking for new ways to maintain aculture where our people excel and lead healthy, happy lives. Learn more about Life at Deloitte.

Corporate citizenship

Deloitte is led by a purpose: to make an impact that matters.This purpose defines who we are and extends to relationships with our clients,our people and our communities. We believe that business has the power toinspire and transform. We focus on education, giving, skill-based volunteerism,and leadership to help drive positive social impact in ourcommunities. Learn more about Deloitte s impact on the world. at http://www2.deloitte.com/us/en/pages/about-deloitte/articles/deloitte-corporate-citizenship.html

Recruiter tips

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Category: Finance

About Deloitte

As used in this document, Deloitte means Deloitte LLP and its subsidiaries. Please see www.deloitte.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law.

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