Government Programs Claims Analyst - Metrics and Monitoring

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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:

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

Primary Job 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.

#LI-Hybrid

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

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.