Senior Grievance and Appeals Coordinator (copy) at Delta Dental of California in Oakland, California

Posted in Other 27 days ago.





Job Description:

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 Grievance & Appeals Coordinator role will communicate vitals and prioritization, and clear obstacles preventing appeal and grievance front line team members from achieving targets each day. As a Senior Grievance & Appeals Coordinator, we expect you to be dedicated to high-quality decision-making and improving the member and provider experience.

How you will make an impact:


  • Provides mentoring and coaching to established and newly hired QA/QM coordinators, specialists and representatives.

  • Manages case assignments including appeal review scheduling, point of contact for appeal requester to respond to questions concerning the appeal process, quality assurance process for appeal resolution letter, and liaison for functional inter-departmental dependencies.

  • Researches monthly metrics to identify trends and potential quality improvement.

  • Performs case review audits and monitor specialist and representative case inventory.

  • Develops a working familiarity with applicable regulatory and accreditation requirements.

  • Contributes to team wide goals to improve processes and integrates additional functions into our daily operations.

  • Becomes an in-house expert on CGA related matters to answer questions on the scope and workflows.

  • Provides support on regulatory audits and quality accreditation surveys, as needed.

  • Contributes to team wide goals to improve processes and integrate additional functions into our daily operations.

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

What we look for:


  • 3+ years of related experience and a high school diploma.

  • Strong organization and time management skills with excellent attention to detail.

  • Catalyst for change.

  • Ability to work independently and define an appropriate course of action and follow through to ensure the issue is resolved in a timely manner.

  • Ability to manage multiple conflicting priorities.

  • Knowledge of dental terminology and dental claim processing, procedures, and guidelines.

  • Ability to make effective business recommendations and develop methods and procedures to improve department's effectiveness and efficiency.

  • Demonstrated coaching and training skills.

  • Strong verbal and written communication skills and strong interpersonal skills to work effectively with all levels of staff.

  • A minimum of 3 years assisting team and/or managing projects with multiple stakeholders.

  • Certified Project Management (PMP) - PMI professional preferred.

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

#LI-MB1
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 abut what our values and culture look like in action, connect with us on social media: @lifeatddins on Facebook and Instagram, @deltadentalins on Twitter, and Delta Dental Ins. on LinkedIn. ABOUT Delta DentalDelta 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.