Delta Dental of Massachusetts · 1 day ago
Appeals & Grievances Lead
United States
Full-time
Remote
Mid, Senior Level
$75K/yr - $101K/yr
3+ years expDelta Dental of Massachusetts is seeking an Appeals & Grievances Lead to oversee the daily operations and performance of the Appeals & Grievances program. This role involves providing subject matter expertise, guidance, and leadership to ensure timely and compliant resolution of appeals and grievances, while driving process improvements and quality outcomes.
Health Care
Responsibilities
Oversee workflow management to ensure cases are processed accurately and within required turnaround times
Ensure compliance with state and federal standards and internal policies
Serve as a subject matter expert for appeals and grievances policies, regulations, and best practices
Provide leadership and support to an Appeals & Grievances Coordinator with handling appeals and grievance cases
Support reporting, quality assurance, performance metrics, and timeliness standards
Review complex or escalated appeal and grievance determinations
Identify trends, root causes, and opportunities for process improvement
Collaborate with cross-functional teams to investigate appeals and grievance cases
Contribute to policy development, training, and continuous improvement initiatives
Qualification
Required
Bachelor's degree in Healthcare Administration, Business, or a related field (or equivalent experience)
3-4 years of experience with insurance operations ideally in an appeals and grievances or customer service area
Strong analytical, organizational, and decision-making skills
Strong customer service skills and customer service focus
Ability to work independently and efficiently use technology
Demonstrate a high degree of good judgement, maturity, and tact to successfully manage member concerns and expectations
Preferred
Knowledge of commercial appeals and grievances regulations and compliance
Prior supervisory or lead team member experience
Experience with appeals and grievances tracking systems or case management software
Prior experience working in a remote environment
Benefits
Medical, dental, and vision plans
Generous time off including PTO
Short and long-term disability insurance
Competitive 401(k) savings match including financial planning workshops
Company
Delta Dental of Massachusetts
Delta Dental of Massachusetts is a dental carrier providing dental plans.
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
unknownKey Investors
SMILE Health
2023-08-08Non Equity Assistance
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