Regulatory Compliance Manager

Job Title: Regulatory Compliance Manager Number of Positions: 1 Location: Nashville, TN Location Specifics: Hybrid Position Job Summary: Must reside in Metropolitan Davidson County, Tennessee or a county contiguous to Metropolitan Davidson County, Tennessee.  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 Plans,   organize s , and oversees the administrative and technical functions of the   Government   Programs   S pecial   I nvestigation   U nit (SIU)   team s ,   including claims, data ,   research and review,   and audits and investigations, to ensure   regulatory, contractual,   corporate and departmental goals and objectives are met. Primary Job Responsibilities Manages the administrative and technical functions of the Government Programs SIU team, including claims, data research and review, and audits and investigations, to ensure the achievement of corporate strategies, goals, and objectives.  Manages and administers all SIU processes, including claims, data research and review, and audits and investigations, for Government Programs business as assigned.  Interviews, hires, trains, mentors, evaluates, and develops staff to ensure accountability for the achievement of corporate, departmental, and individual goals and objectives. Manages staff involved in data research and review, the development of reports, and acts as a consultant to internal and external customers on reporting, analytics, and research issues.   Develops, monitors, and enforces policies, procedures, guidelines, and standards for audits and investigations. Develops and prepares departmental reports and analyzes business processes and information to ensure all applicable regulatory and contractual requirements are met.    Aids law enforcement agencies or attorneys in the decision, defense, and prosecution of fraud, waste, and abuse, including responding to subpoenas, preparing documentation, and testifying in administrative or judicial proceeding regarding violations of contracts.   Develops and maintains trusted relationships with business partners to provide guidance, assess requirements, and promote the use of services and enterprise solutions where appropriate to achieve business partner goals.    Serves as a subject matter expert for data research and review, audit and investigations, and SIU claims processing questions as it…