• Job Description

  Req#: 2625

  *Please note that the Appeals Specialist role is a hybrid position that requires the employee to come in the regional office as needed and reside within a reasonable distance of our Rancho Cordova, CA office.

  Delta Dental is seeking a dedicated Appeals Specialist to join our team. As an Appeals Specialist, you will be responsible for researching, resolving, and processing priority inquiries, disputes, appeals, and grievances from members and providers. You will ensure that all requests are handled within specified timeframes, contributing to our commitment to exceptional customer service.

  Qualifications

  • High school diploma or GED required.
  • 1+ years of inventory management (production-based) experience.
  • 1+ years of experience in healthcare or dental with a focus on appeals preferred. Administrative experience outside of healthcare and dental will be considered.
  • Ability to work a starting schedule of 6 a.m. to 2:45 p.m. pacific, Monday through Friday.
  • Proficient in MS Office, especially Excel (pivot tables and formulas).
  • Excellent written and verbal communication skills.
  • Strong attention to detail.
  • Problem-solving and critical thinking skills, with the ability to identify, conduct research, and follow through on issue resolution.
  • Passionate about improving the healthcare experience for our members.
  • Energized by helping people and seeing the positive impact of your efforts.
  • Resourceful and enjoy solving complicated problems to get to the root cause.

  
  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 14. $36,900 $74,600

  Responsibilities

  • Research and resolve inquiries, appeals, and grievances by communicating directly with members, providers, clients, and internal departments.
  • Enter denials and appeal requests into the information system, preparing documentation for further review.
  • Utilize systems and available resources to conduct thorough research on issues.
  • Ensure timeliness and appropriateness of administrative appeals according to State, Federal, and Delta Dental Healthcare guidelines.
  • Request, obtain, and document detailed invoices as needed for research purposes.
  • Determine appropriate language and prepare responses to appeals.
  • Generate and mail administrative appeal letters.
  • Coordinate problem-solving efforts for interdepartmental issues efficiently and timely.

• About the company

  The Delta Dental Plans Association is composed of 39 independent Delta Dental member companies operating in all 50 states, the District of Columbia and Puerto Rico.

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