Job Title:

Business Rules Specialist

Number of Positions:

1

Location:

Okemos, MI

Location Specifics:

Hybrid Position

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 for all. 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, develops, tests, and executes the automated business rules governing group contract administration within the claims processing system in order to ensure accurate and timely payments.

Primary Job Responsibilities:

• Analyzes and interprets group contract requirements.

• Identifies the business rules needed to ensure the accurate administration of group contract requirements, including applicable DeltaUSA and standard administrative processing policies and the American Dental Association procedure codes.

• Analyzes, develops, tests, and executes automated business rules to ensure that expected results are achieved.

• Develops test cases and scenarios, tests system functionality, and approves final business rules, including on behalf of other Delta Dental plans and business partners as necessary and assigned.

• Leads the business rule based component of all applicable claims processing system conversions on behalf of other Delta Dental plans and business partners, including identifying, analyzing, and troubleshooting potential gaps, and provides post conversion guidance and support.

• Analyzes proposed rule enhancements and process improvements and provides recommendations designed to improve claims processing efficiency and accuracy.

• Organizes and maintains department records, including historical business rules and claims processing decisions and related reference materials.

• Trains other departments, Delta Dental plans, and business partners regarding internal procedures, system functions, and business rules processes.

• 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, computer science, or a related field and three years of experience auditing or reviewing dental claims, administering group dental contracts, responding to dental benefit inquiries, or resolving dental benefit administration issues. One year of dental chairside assisting is preferred. Will accept any suitable combination of education, training, or experience.

Position requires advanced knowledge of dental terminology and American Dental Association procedure codes; knowledge of claims processing policies, procedures, and systems; knowledge of word processing, spreadsheet, and database applications; strong verbal and written communication skills; strong analytical skills; and the ability to resolve complex 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.