Manager Grievance & Appeals

Delta Dental of California; Camp Hill (Cumberland County); Hybrid; USD 72,000 - 151,000; Full time

Benefits offered by this job

Competitive base and incentive pay

401(k) with robust matching

Rich medical & pharmacy benefits

100% employer-paid dental and vision

Holistic wellbeing program

Paid time off + holidays

Career development & tuition

Adoption and family support

Volunteer opportunities

Employee discount program

Job summary

Delta Dental of California is seeking a Manager Grievance & Appeals to lead the department, oversee staff, and ensure compliant processing of claims across multiple state standards. The role emphasizes staff development, process optimization, and strong collaboration with business owners to reduce grievance volumes while delivering high-quality care.

Requirements include 5+ years in healthcare operations and 1+ year in supervision, plus excellent communication and organizational skills.

Qualifications

• 5+ years of healthcare operations experience.
• 1+ years of supervisor or management experience.
• Strong critical thinking and analytical skills.
• Excellent organizational and time management abilities.
• Strong interpersonal, written, and verbal communication skills.
• Exceptional inventory management skills.
• Proficiency with Microsoft Office programs (Word, Excel, Outlook).
• Ability to maintain strict confidentiality.

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.

Skills

Healthcare operations

Management experience

Critical thinking

Time management

Communication skills

Inventory management

MS Office

Confidentiality

Job description

Manager Grievance & Appeals

The 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.

• 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.

• 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.

Behind the smile! We are dedicated to safeguarding the health and financial stability of our employees and their loved ones. This commitment extends beyond the workplace to foster personal growth and holistic wellbeing.

Our life-changing rewards package includes:

• 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.

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.

Hybrid