Manager, Government Programs Third Party Liability and Coordination of Benefits

Job Title:

Manager, Government Programs Third Party Liability and Coordination of Benefits Number of Positions:

1

Location:

Okemos, MI Location Specifics:

Fully Remote 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 Provides strategic leadership and operational oversight of Government Programs Third Party Liability operations (TPL) and Coordination of Benefits (COB) to ensure accurate identification, coordination, recovery and reporting of third-party coverage in compliance with federal and state Medicare and Medicaid regulations. Leads the end-to-end Government Programs TPL/COB strategy, cost avoidance, post-payment recovery, and vendor management, ensuring program performance meets contractual, regulatory, and financial objectives. Designs, documents, and implements TPL/COB policies, procedures and workflows aligned with CMS Medicare and state Medicaid requirements, translating regulatory requirements into operational practice. Develops, monitors, and reports key performance metrics related to recoveries, cost avoidance savings, and accuracy; drives accountability through regular performance reviews and action planning. Identifies and executes opportunities to improve TPL/COB recovery yield, increase automation, strengthen controls, and enhance overall operational efficiency across TPL/COB processes. Serves as the Government Programs TPL/COB subject matter expert, providing guidance on benefit coordination, payment order, recovery methodologies, and operational interpretation of regulatory requirements. Champions TPL/COB processing enhancements and cross-functional initiatives that advance Government Programs goals, including system improvements, workflow redesign, and change management adoption. Partners with business and technology stakeholders to define and deliver the TPL/COB strategic roadmap, including requirements definition, prioritization, implementation planning, and clear communication of impacts to affected teams. Leads and coordinates support for CMS, state and other regulatory audits and reviews related to TPL/COB, including data requests, documentation, issue remediation, and ongoing compliance monitoring. Interviews, hires, trains, develops, and evaluates staff in order to ensure accountability for the achievement of corporate and department goals and objectives. #

LI-Hybrid Minimum Requirements:

Position requires a bachelor's degree in healthcare administration, business administration, finance or a related field, seven years of government programs third party liability/coordination of benefits experience, and three years of leadership experience. Will accept any suitable combination of education, training, or experience. Position requires advanced knowledge, experience and understanding of state and federal regulations related to TPL/COB for government programs including Medicare and Medicaid; strong verbal and written communication skills, including the ability to present on behalf of the organization; strong interpersonal skills; strong analytical skills; strong advocacy skills; ability to identify and partner with key business leaders; ability to lead and motivate others; ability to identify and resolve the most complex TPL/COB related issues using independent judgment, and the ability to work under pressure and manage multiple complex priorities. 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. Delta Dental of Michigan, Ohio, and Indiana has been a dental benefits leader for more than 60 years, and today with our affiliates, we are one of the largest dental plan administrators in the country. It's our mission to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by making investments that build healthy, smart, vibrant communities. We celebrate diverse thought and foster a culture where employees go All In - for the company, themselves, their colleagues and their communities. Employees are offered a comprehensive benefits package that includes medical, dental and vision coverage, short- and long-term disability, life insurance, 401(k) savings plans, flexible spending accounts, and tuition reimbursement or educational assistance. Employees are also eligible for annual incentive compensation based on annual business goals. Additionally, employees receive eight hours of paid volunteer time each year, access to an on-staff health coach and personal trainer, plus many other perks. Delta Dental is an Equal Opportunity Employer.