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Senior Regulatory Exam Audit Analyst - Sacramento

Delta Dental of California
United States, California, Rancho Cordova
June 18, 2022
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 Senior Regulatory Exam Audit Analyst is responsible for the overall success of each audit or exam assigned. This includes analyzing and reviewing requested information, advising the business and/or forming responses, proposing different options for resolving issues, interpreting and documenting requirements, conducting meetings as needed (externally and internally), and alerting management of potential issues. Other responsibilities include collaborating with internal customers to ensure the audit/exam responses are accurate, timelines are met, and their internal activities are compliant. The incumbent also acts as a trainer and mentor to other team members, provides strong industry knowledge and understanding of the enterprise's structure, and is a trusted SME for all audit/exam activities.

How you will make an impact:

  • Manages all audits/exams as projects, focusing on audits and exams with added complexity. Establishes tasks, timelines, and deliverables to meet deadlines with dependencies on other departments. Identifies, engages, and collaborates with respective stakeholders throughout each project.
  • Creates and/or provides guidance in the drafting of audit/exam responses that align with current process and materials and may be referenced in the audit/exam, ensuring accurate, defendable, clear, and concise responses. Reviews lower-level team members' responses prior to submission.
  • Analyzes unexpected findings or trends and shares analysis, potential risks, and recommendations with stakeholders to support adherence to compliance standards.
  • Completes Root Cause Analysis for each issue or Corrective Action Plan (CAP). Manages and tracks issue to completion to prevent repeat findings.
  • Provides monthly assessment on adherence to compliance standards, open corrective action plans, and/or performance guarantees.
  • Researches and resolves issues related to outdated information or unclear processes; Proactively creates and/or enhances audit tools to mitigate potential future issues and provides feedback or recommendations to management.
  • Leads cross-functional meetings to update stakeholders on pertinent issue resolutions, process changes and improvements, and/or system enhancements.
  • Acts as a subject matter expert to team members and consults on complex or escalated issues; Trains and mentors lower-level team members on department concepts, practices, procedures, policies, processes and/or issue resolution.
  • Creates and maintains current desk level procedures (DLPs), reporting, training, and audit tools to support the success of audits and exams.
  • Provides guidance on monitoring audit/exam activities in order to meet compliance standards, contractual obligations, and/or performance guarantees with clients and legislative and regulatory bodies; Analyzes policies, procedures, and business process modifications for compliance.
  • Researches and analyzes findings related to non-compliance with laws, rules, or regulations (including those related to the Centers for Medicare and Medicaid) and proactively advises on tools or processes to mitigate potential future issues.
  • Coordinates interactions with insurance regulators, Commercial/Medicare/Medicaid group client auditors, and internal stakeholders.
  • Collaborates in identifying mitigating facts and circumstances (as applicable) to respond to potential findings identified during regulatory audit/exams, including the various stages of the audit/exam workflow.
  • Keeps abreast of the full lifecycle of identified audit/exam findings.
  • Provides regular updates to management (including preparing business partners for meetings with regulators) regarding audits/exams in progress including the tracking and resolution of queries, reviews with the area under audit/examination, and the materials requested to ensure completeness and responsiveness of submissions.
  • This list is not all-inclusive and you are expected to perform other duties as requested or assigned.

What we look for:

  • 4+ with a Bachelor's degree.
  • Health insurance regulatory (including Medicare/Medicaid) experience required.
  • Strong organizational/time management skills and multi-tasking abilities.
  • Detail-oriented with strong analytical and problem-solving skills.
  • Understands process flows and can identify roadblocks and devise solutions to improve processes.
  • 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.
  • Effectively able to teach less-senior employees department processes, policies, and concepts.
  • 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.

Benefits and perks:

  • 12 days starting vacation, 12 holidays, 9 sick days and your birthday off!
  • Low-cost premium medical insurance options
  • 100% paid dental and vision insurance
  • Generous 401(k) matching and flat contribution
  • Social responsibility and volunteer opportunities, including 16 paid volunteer hours annually
  • Employee Live Well program, focusing on overall employee well-being
  • Fertility and diabetes benefits
  • Employee discount program: AT&T/Verizon, entertainment, travel, and more!
  • Culture of learning: career development and tuition reimbursement
  • Career growth: we love promoting from within
Please note, Delta Dental will not sponsor applicants for work visas for this position.
#LI-JB1
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!
To see some of the smiling faces behind Delta Dental and to learn more about what our values and culture look like in action, connect with us on social media: Delta Dental Ins. on and , #Lifeat D D ins on and , , and Delta Dental Ins. on .
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.
Unfortunately, our Delta Dental Enterprise is unable to hire individuals residing in Alaska, North Dakota, Nebraska, Hawaii, Oklahoma, Vermont, Maine, West Virginia, New Hampshire, Wyoming, Puerto Rico or other US Territories at this time.
Proof of eligibility to work in the United States must be provided if selected for hire.
Delta Dental* has enacted a COVID-19 vaccination policy to protect all employees and the communities we serve due to the ongoing impacts of the COVID-19 pandemic. Accordingly, we require all employees to be fully vaccinated for COVID-19. Are you able to comply with our policy of being fully vaccinated by your start date if an offer is made or have a medical or sincerely held religious exemption for receiving a COVID-19 vaccine? Failure to comply with our policy and submit proof of compliance or receive approval for a valid medical or sincerely held religious belief exemption prior to your start date will nullify any offer of employment extended to you.
*Delta Dental includes: Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, and Delta Dental of New York
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