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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.
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.
- 2+ w/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
Base Pay Information
The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental’s assessment of the candidate’s knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity. $55,000 - $116,900
- Competitive base and incentive pay
- 401(k) with robust matching and non-matching contributions
- Rich medical & pharmacy benefits
- 100% employer-paid dental and vision benefits
- Holistic wellbeing program with deep financial incentives
- Generous paid time off plus 12 paid holidays and your birthday off
- Culture of growth and learning: career development; tuition reimbursement; recognition program
- Family support: adoption assistance, fertility treatment, child, elder & pet care assistance
- Social responsibility and volunteer opportunities
- Employee discount program
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What We Do
At Delta Dental, we’re behind millions of smiles and counting. For over 68 years, we’ve served our communities by increasing access to affordable, quality care – but that commitment to care extends beyond the people we serve, to the dedicated employees who make those smiles genuine. We've come this far by building programs that offer opportunities for advancement, create meaningful connections, and improve the lives of our employees and their families. Because we know that when we take exceptional care of each other, we can make a positive impact for all. We champion an inspirational workplace through our commitment to trust, service, excellence and innovation. Joining us means working for a company that offers stability and balance, opportunities for leadership at all levels, and a work environment. Delta Dental of California, Delta Dental of New York, Inc., Delta Dental of Pennsylvania, and Delta Dental Insurance Company are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies throughout the country. Together with our affiliate companies, form one of the nation’s largest dental benefits delivery systems, covering over 31 million enrollees. Headquartered in San Francisco, we are members of the Delta Dental Plans Association, a network of companies that provides dental coverage to 80 million people. Delta Dental provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Delta Dental complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
