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Deloitte Program Integrity – Consultant (Dental Claims Analyst – Recovery) in San Francisco, California

Are you an analytical, data-driven professional? Are youinterested in a role that uses leading edge analytics and offers an opportunityto provide front line support to solve our clients most challenging problemsassociated with health care Payment Integrity / Fraud, Waste and Abusedetection and prevention? If so, the Forensic Analytics practice is the placefor you!

As a data analyst, you will be expected to apply yourspecialized knowledge of data acquisition, management, analysis, andinterpretation directly to dental claims, eligibility, policy, etc., data,providing actionable insights that Deloitte, our clients, decision-makers, andothers can use. It s a great career choice for those who want to applyhealthcare expertise in a novel and innovative way.

Forensic Analytics is a fast-growth practice within Deloitte Riskand Financial Advisory that centers around several of the hottest areas ofbusiness today analytics, forensic analysis, and litigation support and thespecialized skills that make careers in these areas both fascinating and inhigh-demand. Our Analytics team makes extensive use of data, statistical andquantitative analysis, rules-based methods, and explanatory and predictivemodeling to bring insights to client issues. Our work increasingly employsspecialized competencies, such as advanced analytics, visualization, andgeospatial techniques.

Workyou ll do

  • Provide domain experience in review of dental plan policy

  • Guide the development and review of new dental rules

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

  • Conducting dental recovery analytics to identify potential fraud, waste, abuse, or improper payment.

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

  • Query and mine large health care related data sets to discover transaction patterns, examine financial data and filter for targeted information

  • Gather and interpret data from a variety of sources (e.g., claims, eligibility, contract /pricing, cost reports)and critically evaluate it, reconcile conflicts, disseminate high-level information into details and distinguishing user requests from their true needs

  • Query and mine large data sets to discover transaction patterns, examine financial data and filter for targeted information

  • Design and develop models and solutions that use predictive analytics, text analytics and cognitive computing, and big data frameworks, in order to find anomalies and hidden patterns

  • Provide assistance interpreting needs of customers and translating them into the application and operational requirement with the help of product management skill

  • Assist in preparing and presenting complex written and verbal materials (reports, findings and presentations)

  • Review deliverables for accuracy and quality

  • Contribute to new business proposals and proposal development

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

The team

As a member of ourForensic Analyticspractice in the Consultant role, youwillwork on projects that will allow you to collaborate with clients, and other analystsand investigators. As part of these projects, you ll be provided theopportunity to demonstrate your technical, project management and leadershipskills in an environment that provides for outstanding growth and advancement. Positionmay necessitate intermittent travel and requires flexibility with the clientservice projects.


Minimum Qualifications:

  • Bachelor s Degree in Economics, Finance, Statistics, Mathematics, Computer Science, Management Information Systems, Engineering, Business Analytics disciplines, or related area

  • Experience with dental data analytics

-{PS..0}->1-3years of hands-on technical experience miningand analyzing transactional electronic data.

  • Proficiency in word processing, spreadsheet, and presentation creation tools, as well as Internet research tools

  • Professional demeanor and strong communication skills, both written and oral

  • Demonstrated problem solving and troubleshooting skills with experience exercising mature judgment

  • Ability to work independently and manage multiple projects and responsibilities in a fast-paced environment

  • Proven experience effectively prioritizing workload to meet deadlines and work objectives

  • Experience working in Payment Integrity / FWA detection and prevention space is a plus

-{PS..1}-> Must be legally authorized to workin the United States without the need for employer sponsorship, now or at anytime in the future.

Preferred Qualifications

  • Previous accounting/audit or analytics experience in a professional services firm

-{PS..2}->Bachelor sDegree inEconomics, Finance, Statistics,Mathematics, Computer Science, Management Information Systems, Engineeringor a professional affiliation such as CPA, FCPA, CFE, MBA,ASA, and/or CFA

  • 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

Howyou ll grow

AtDeloitte, our professional development plan focuses on helping people at everylevel of their career to identify and use their strengths to do their best workevery day. From entry-level employees to senior leaders, we believe there salways room to learn. We offer opportunities to help sharpen skills in additionto hands-on experience in the global, fast-changing business world. Fromon-the-job learning experiences to formal development programs at DeloitteUniversity, our professionals have a variety of opportunities to continue togrow throughout their career. ExploreDeloitte University, The Leadership Center. at


AtDeloitte, we know that great people make a great organization. We value ourpeople and offer employees a broad range of benefits. Learn more about what working at Deloitte can mean for you. at

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Category: Finance

About Deloitte

As used in this document, Deloitte means Deloitte LLP and its subsidiaries. Please see 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.