Complaints, Grievances & Appeals Specialist II (DQ)

DentaQuest; Milwaukee (WI); On-site; USD 45,000 - 65,000; Full time

Job summary

DentaQuest in Milwaukee seeks a Complaints & Grievances Specialist II to investigate and resolve member complaints, grievances, and appeals under regulatory requirements.

You will assemble Maximus packets and State Fair Hearing materials, coordinate with market and internal teams, and ensure turnaround times and workflows are followed.

Qualifications

• Investigate and resolve complaints, grievances and member appeals per regulatory requirements.

Responsibilities

• Assemble and prepare Maximus packets and State Fair Hearing packets.
• Coordinate and participate in State Fair Hearings.
• Interact daily with assigned market/client contacts and internal departments.
• Ensure mandated turnaround times and required processes/workflows are adhered to.

Job description

At DentaQuest, we believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.

Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it.

To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and deliveringmeasurableoutcomes for the people we serve.

The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.

ABOUT THE POSITION

The Complaints & Grievances Specialist II is responsible for the investigation and resolution of complaints, grievances and member appeals based upon specific regulatory requirements. In addition, responsible for the assembly and preparation of Maximus packets, State Fair Hearing packets as well as coordination and participation in State Fair Hearings. Responsible for daily interaction with assigned market/client contacts, as well as various internal departments. This position is also responsible to ensure that all mandated turnaround times are met as well as required processes and workflows are adhered to.