Job Description:

Due to COVID-19, there is an even greater demand for flexibility and change. Due to the pandemic, the expectation around work location for certain roles may be remote until a future date, determined by Delta Dental Management. Should the position you seek be determined by Delta Dental Management as remote, the position may require you to have access to remote internet in order to meet the expectations outlined in the job duties.

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AT DELTA DENTAL WE:
PROMOTE ACCOUNTABILITY, INTEGRITY AND COLLABORATION: Our employees are collaborative, self-aware, and ethical. It is our expectation to do the right thing and follow through on commitments.
FOSTER PROFESSIONAL DEVELOPMENT: Our employees take ownership of developing themselves and others through coaching, mentoring and providing/being open to constructive feedback and identifying learning opportunities.
VALUE CUSTOMERS AND CULTIVATE POSITIVE EXPERIENCES: Our employees take time to build rapport with customers, while anticipating and exceeding their needs to ensure positive outcomes.

If you think this sounds like you, let s chat. We would love to tell you more!

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ABOUT DELTA DENTAL
Delta Dental covers more Americans than any other dental benefits provider. Our vision is to motivate and empower every employee so we re all inspired to take exceptional care of our customers, providers and each other. Our Enterprise Strategy focuses on pillars of Growth and Diversification, supported by the platforms of Culture and People, Process and Technology. Our employees take pride working for a purpose-driven organization and live our values of Trust, Service, Excellence and Innovation.

We are part of the Delta Dental Plans Association, a network of companies that provides dental coverage to 74 million people in the U.S. Delta Dental of California, Delta Dental of New York, Inc., Delta Dental of Pennsylvania and Delta Dental Insurance Company, together with our affiliate companies, form one of the nation s largest dental benefits delivery systems, covering 33 million enrollees. All of our companies are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies throughout the country.

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, genetics, or any other classification protected by federal or state law. 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.

Proof of eligibility to work in the United States must be provided if selected for hire.
At Delta Dental, our strategy is only as strong as the people who execute it! We are hiring individuals that are not just right for today but also for our future. We have built a foundation of high-trust by treating all people with dignity, making and keeping commitments, and consistently striving to do the right thing. Our leaders optimistically share future possibilities to inspire and motivate others toward their full potential. We expect our employees to find ways to embrace positive change, be curious and challenge the status quo, and provide solutions to unmet problems. Joining Delta Dental means joining a culture focused on fostering development, building genuine connections, recognizing each other s strengths and sharing in successes.

The Supervisor of Claims Operations is responsible for supervising the daily functional areas of claim operations and provides collaborative oversight with other operational leaders to help drive excellence in claim processes. The scope of oversight includes the monthly activities of capitation processes for a DHMO program, such as Capitation payments, Capitation adjustment processes and implementation of new or updated processes.

How you will make an impact:

* Monitors the monthly capitation cycle and conducts monthly review of all error and payment reports to ensure accurate and timely compensation payments to providers.

* Audits and reports findings through JIRA request or to the accountable business area for correction.

* Initiates work request projects related to the capitation payment cycle as needed.

* Collaborates with other business analysts and cross-functional team members to correct defects resulting in over or under payment of capitation and other claim payments.

* Develops and conducts internal and cross-functional team training regarding capitation processes.

* Develops data for research and analysis to support proposed improvements in operational processes to increase automation, decrease loss costs, and improve operational efficiencies.

* Acts as a subject matter expert and collaborative partner in system and process enhancement efforts, including analysis, development of recommendations, testing, execution, and post-implementation evaluation.

* Works with a Product team in implementation of NICE Performance Management and desktop analytics in a claim production environment.

* This list is not all-inclusive and you are expected to perform other duties as requested or assigned.

What we look for:

* 5 years of experience and an Associate s degree required.

* Supervisory experience preferred.

* Ideal candidate will have experience in Lean Six Sigma methodologies and professional certification to demonstrate experience in process reviews.

* Experience using NICE performance management and desktop analytics in a claims production environment is a plus.

* Strong organizational and time-management skills, including the ability to perform and prioritize multiple tasks or project initiatives seamlessly.

* Detail-oriented; flexible and creative.

* Skill in using logic and reasoning to identify solutions, conclusions, or approaches to processes.

* Strong interpersonal and communications skills to work effectively with all levels of staff.

Benefits and perks:

* 12 days starting vacation plus 12 holidays and your birthday off!

* Multiple medical insurance options: 100% paid or low cost premiums

* 100% paid dental insurance

* 100% paid vision insurance

* Onsite gym and/or gym discount and fitness incentive

* Culture of learning: substantial tuition reimbursement to improve your skills

* Career growth: we love promoting from within

* Strong commitment to work/life balance

* Technology allowance

* Social responsibility and volunteer opportunities

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