Job DescriptionThe Manager Grievance & Appeals will provide leadership and manage the staff and departmental activities of the Grievances & Appeals Department. The role will be responsible for planning and ensuring the efficient operating and adherence to organizational and multiple state-mandated standards and guidelines in regards to the review and processing of claims and Enterprise and divisional goals and objectives. This includes the fulfillment of Delta's commitment to its enrollees and member dentists, and to oversee the delivery of quality dental care and application of policy and guidelines to our purchasers and subscribers.
ResponsibilitiesManages, develops and trains staff to achieve department objectives including determining staffing needs, setting goals, interviewing, selecting, coaching, and evaluating the performance of all direct reports. Manages and, through a team, resolves claim appeal, dispute, and reconsideration case inventory with determination to exceed established regulatory requirements and performance guarantees. Analyzes trends and makes recommendations for processing procedures to ensure efficiency and cost containment. Collaborates with departmental business owners on process improvement to decrease grievance and appeal volume. Develops and implements best practice protocols within the division and the Enterprise. In conjunction with G&A Supervisors and internal partners, delivers process, procedure, and systemic training opportunities and efficiencies to support grievance and appeal team members. Evaluates and implements organizational standards to meet corporate and divisional goals and objectives. Qualifications- 5 or more years of healthcare operations experience, 1 or more years of supervisor or management experience.
- Strong critical thinking and analytical skills.
- Excellent organizational and time management skills, with the ability to multi-task while maintaining attention to detail.
- Strong interpersonal, written, and verbal communication skills.
- Exceptional inventory management skills.
- Intermediate knowledge of Microsoft Office programs, i.e. Word, Excel, Outlook etc.
- Ability to maintain strict confidentiality.
Base Pay Information
The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity.
Pay Grade 20. $72,084 - $150,995
Nationally.#LI-Hybrid
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