Manager Grievance & Appeals

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

Benefits offered by this job

Competitive base pay

Incentive pay

401(k) matching

Medical benefits

Dental benefits

Vision benefits

Wellbeing program

Paid time off

Holidays + birthday off

Career development

Tuition reimbursement

Adoption assistance

Fertility treatment support

Family care support

Volunteer opportunities

Employee discount

Job summary

Delta Dental of California in Oakland seeks a Manager Grievance & Appeals to lead the Grievances & Appeals Department, directing staff and ensuring compliance with state and enterprise guidelines for claims review and processing. The role focuses on achieving organizational goals while safeguarding member dentists and enrollees.

The position emphasizes staff development, process improvements, and cross-functional collaboration to reduce grievance volume while maintaining timely, high-quality

Qualifications

• 5+ years of healthcare operations experience
• 1+ years of supervision or management experience
• Strong critical thinking and analytical skills
• Excellent organizational and time management skills
• Strong interpersonal, written, and verbal communication skills
• Exceptional inventory management skills
• Ability to maintain strict confidentiality

Responsibilities

• Manages, develops and trains staff to achieve department objectives including staffing planning, goal setting, interviewing, selecting, coaching and evaluating direct reports
• Oversees and, through a team, resolves claim appeal, dispute, and reconsideration case inventory to exceed regulatory requirements
• Analyzes trends and recommends processing improvements for efficiency and cost containment
• Collaborates with business owners on process improvements to reduce grievance and appeal volume
• Develops and implements best practice protocols within the division and Enterprise
• Delivers training opportunities and efficiencies to support grievance and appeal team members
• Evaluates and implements organizational standards to meet corporate and divisional goals

Skills

Staff management

Leadership

Analytical skills

Time management

Communication

Confidentiality

Microsoft Office

Process improvement

Tools

Microsoft Office

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