Manager Grievance & Appeals

Delta Dental of California; Alpharetta (GA); Hybrid; USD 72,000 - 151,000; Full time

Benefits offered by this job

Competitive pay

401(k) matching

Medical benefits

Dental & vision coverage

Wellbeing program

Paid time off

Job summary

Delta Dental of California in Alpharetta, GA is seeking a healthcare operations leader to manage, develop and train staff to meet department objectives. You will set staffing, goals, interview and coach, and evaluate performance of direct reports.

In this role you will oversee grievance and appeal processes, analyze trends, and drive process improvements to reduce volume. Hybrid work arrangement and extensive benefits are offered.

Qualifications

• 5+ years of healthcare operations experience and 1+ year of supervisor/management experience.
• Strong critical thinking and analytical skills.
• Excellent organizational and time management skills; multi-tasking with attention to detail.
• Strong interpersonal, written, and verbal communication skills.
• Exceptional inventory management skills.
• Intermediate knowledge of Microsoft Office programs (Word, Excel, Outlook).
• Ability to maintain strict confidentiality.

Responsibilities

• Manages, develops and trains staff to achieve department objectives including staffing needs, goal setting, interviewing, selecting, coaching, and evaluating performance of direct reports.
• Manages and, through a team, resolves claim appeal, dispute, and reconsideration case inventory with focus on regulatory requirements and performance guarantees.
• Analyzes trends and makes recommendations for processing procedures to improve efficiency and cost containment.
• Collaborates with departmental business owners on process improvements to decrease grievance and appeal volume.
• Develops and implements best practice protocols within the division and the Enterprise.
• 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.

Skills

Healthcare operations

Staff supervision

Critical thinking

Organization & time management

Interpersonal communication

Inventory management

MS Office

Job description

Responsibilities

• Manages, 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.

Requirements / 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.

Benefits

• Competitive base and incentive pay


• 401(k) with robust matching and non-matching contributions


• Rich medical & pharmacy benefits


• 100% employer-paid dental and vision benefits


• Holistic wellbeing program with deep financial incentives


• Generous paid time off plus 12 paid holidays and your birthday off


• Culture of growth and learning: career development; tuition reimbursement; recognition program


• Family support: adoption assistance, fertility treatment, child, elder & pet care assistance


• Social responsibility and volunteer opportunities


• Employee discount program

Fair Chance Ordinances and Criminal Background Considerations

This position requires that the applicant undergo a background check. Qualified applicants with arrest or conviction records will be considered for employment in accordance with any applicable federal, state or local laws, including, but not limited to, the California Fair Chance Act, the Los Angeles County Fair Chance Ordinance, the City of Los Angeles Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, and/or New York Corrections Law Article 23-A.

Important Work Authorization Information

Please note, Delta Dental will not sponsor applicants for work visas for this position.

Work Arrangements

Hybrid