Appeals and Grievances Analyst
Delta Dental of Arkansas
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $44,600 - $56,000 per year
About the role
- Research incoming appeals, grievances and complaints, including consideration and reconsideration requests, to properly identify and categorize as processed claims (grievances), denied services (appeals or self-funded (ASO) group requests) or complaints
- Collect all appropriate data and information, and process for clinical or contract consideration as appropriate.
- Coordinate case review with dental consultants.
- Coordinate timely handling and resolution responses for high volume of appeals and grievances within various regulatory and contractual timelines
- Reconcile across systems to ensure that all member appeals and grievance are logged and tracked.
- Direct external independent reviews to the appropriate independent review organization (IRO)
- Document records in accordance with DOI guidance requirements
- Prepare and manage all monthly and quarterly customer and internal reporting
- Communicate effectively with other departments such as Claims and Customer Service, Billing & Eligibility, Marketing and Professional Relations to ensure complete and fair reviews of complaints, grievances and appeals
Requirements
- High school diploma or equivalent required
- 2-4 years of related experience
- Knowledge of insurance laws and regulations
- Ability to read and understand benefit plans
- Familiarity with dental terminology
- Thorough understanding of relevant State and Federal laws, DDAZ regulations and group policies and procedures
- Solid analytical and problem-solving skills
- Excellent verbal and written communication skills
- Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint
Benefits
- medical
- dental
- vision
- 401(k)
- student loan assistance
- six weeks of paid parental leave
- volunteer PTO
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
data processingcase reviewrecord documentationanalytical skillsproblem-solving skillsinsurance lawsbenefit plan comprehensiondental terminologyregulatory compliancereporting
Soft Skills
communication skillscoordinationtimelinessattention to detailinterdepartmental collaboration