Manager Of Grievance And Appeals

JOB DESCRIPTION
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.
RESPONSIBILITIES

• 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.
• Analyzes trends and makes recommendations for processing procedures to ensure efficiency and cost containment.
• Manages and, through a team, resolves claim appeal, dispute, and reconsideration case inventory with determination to exceed established regulatory requirements and performance guarantees.
• Collaborates with departmental business owners on process improvement to decrease grievance and appeal volume.
• 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.
• Evaluates and implements organizational standards to meet corporate and divisional goals and objectives.
• Develops and implements best practice protocols within the division and the Enterprise.

QUALIFICATIONS

• Strong critical thinking and analytical skills.
• Strong interpersonal, written, and verbal communication skills.
• Excellent organizational and time management skills, with the ability to multi-task while maintaining attention to detail.
• 8+ years w/Bachelor's degree; 1+ years supervisory/management
• Minimum 5 years' experience in health insurance, with 3 years' experience in grievance and appeals and/or healthcare regulation and law
• Exceptional inventory management skills.
• Ability to maintain strict confidentiality.
• Intermediate knowledge of Microsoft Office programs, i.e. Word, Excel, Outlook etc.

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. $70,000 - $146,600
ADDITIONAL INFORMATION
Rewards to make you smile! We don't just want to make our customers happy - we want to give our employees a reason to smile, too. Delta Dental's comprehensive benefits package includes:

• Culture of learning: career development and tuition reimbursement
• Low-cost premium medical insurance options
• Fertility and diabetes benefits
• Generous paid time off plus 12 holidays and your birthday off!
• Career growth: we love promoting from within
• Generous 401(k) matching and flat contribution
• 100% paid dental and vision insurance
• Employee discount program: AT&T/Verizon, entertainment, travel, and more!
• Social responsibility and volunteer opportunities, including 16 paid volunteer hours annually
• Employee LiveWell program, focusing on overall employee well-being

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
Please note, Delta Dental will not sponsor applicants for work visas for this position.
#LI-Hybrid
ABOUT THE TEAM
At Delta Dental, our success is only as strong as the people who execute it! We take enormous pride in being the nation's most recognized and widely-used provider of dental insurance - and we've come this far by living our core values of innovation, excellence, service and trust. Our vision is to motivate and empower every employee so that we're all inspired to take exceptional care of our customers, providers and ourselves. We believe in integrity, accountability, collaboration, and giving every employee equitable opportunity for their voice to be heard and development to be fostered.
If you're excited about the prospect of transforming the future of health care and growing in your career, join our smile revolution!
To see some of the smiling faces behind Delta Dental and to learn more about what our values and culture look like in action, connect with us on social media: Delta Dental Ins. on Facebook and Instagram, #LifeatDDins on Facebook and Instagram, Delta Dental Ins. on Twitter and Delta Dental Ins. on LinkedIn.
We are part of the Delta Dental Plans Association, a network of companies that provides dental coverage to 74 million people in the U.S. Delta Dental of California, Delta Dental of New York, Inc., Delta Dental of Pennsylvania and Delta Dental Insurance Company, together with our affiliate companies, form one of the nation's largest dental benefits delivery systems, covering 33 million enrollees. All of our companies are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies throughout the country.
Delta Dental is an equal opportunity employer. We are committed to building and maintaining a diverse and inclusive workplace for all employees. Applicants will not be discriminated against because of race, color, religion, creed, national origin, ancestry, citizenship status, sex (including pregnancy), sexual orientation, gender or identity expression, age, disability, marital status, medical status, veteran status or any other status protected under federal, state, or local law. In addition to federal law requirements, Delta Dental complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Unfortunately, our Delta Dental Enterprise is unable to hire individuals residing in Alaska, North Dakota, Nebraska, Hawaii, Oklahoma, Vermont, Maine, West Virginia, New Hampshire, Wyoming, Puerto Rico or other US Territories at this time.
Proof of eligibility to work in the United States must be provided if selected for hire.
Delta Dental* has enacted a COVID-19 vaccination policy to protect all employees and the communities we serve due to the ongoing impacts of the COVID-19 pandemic. Accordingly, we require all employees to be fully vaccinated for COVID-19. Are you able to comply with our policy of being fully vaccinated by your start date if an offer is made or have a medical or sincerely held religious exemption for receiving a COVID-19 vaccine? Failure to comply with our policy and submit proof of compliance or receive approval for a valid medical or sincerely held religious belief exemption prior to your start date will nullify any offer of employment extended to you.

• Delta Dental includes: Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, and Delta Dental of New York