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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:

Responsible for ensuring due diligence in the completion of Problem Reports and Corrective Action Plans (CAPs) to ensure solutions are effective and sustainable. Strengthens compliance, improves processes, builds trust with regulators and clients, and coordinates operational problem resolution to reduce corporate risk, errors and unintended consequences, monitors remediation, and quality issues while meeting stakeholder expectations.

Primary Job Responsibilities:

• Facilitates problem resolution from identification and impact assessment through root cause analysis, containment, remediation, and prevention.
• Analyzes root cause trends and recommends systemic improvements to reduce deficiencies, costs, and recovery time.
• Collaborates with cross-functional teams including Compliance, Operations, and IT to ensure Problem Reports and CAPs are realistic, measurable, and aligned with customer and business goals.
• Tracks and monitors Problem Reports and CAP progress and open corrective actions. Confirms completion and effectiveness, and recommend improvements to reduce risk, impact, and recurrence.
• Provides regular status updates to leadership and stakeholders to ensure internal and external due dates are met.
• Facilitates and educates teams on the Problem Reporting and CAP processes, compliance requirements, and preventive measures.
• Submits completed CAP and/or Problem Reports and supporting evidence to external clients in accordance with contractual obligations.
• Maintains Problem and CAP records, monitors actions, identifies trends, and reports results to management to validate the ability to meet internal and external audit requirements.

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 business administration, health administration, or related field and three years' experience auditing, quality monitoring, risk management, or operations. Will accept any suitable combination of education, training, or experience.

Position requires general business knowledge and strong interpersonal skills; basic understanding of how to identify the cause of problems, resolve issues, improve quality, and reduce risk; familiarity with insurance products, common insurance terms, claims or service processes, and standard business procedures; knowledge of regulatory frameworks relevant to our industry (e.g., CMS, Medicare Advantage, etc. applicable regulations) preferred; ability to analyze, investigate, and resolve minor to complex business problems using creative thinking and problem solving skills; ability to effectively communicate and facilitate resolution in difficult situations; ability to manage competing priorities; and the ability to solve 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.