Appeals and Grievance Coordinator (Dental)

US-CA-Los Angeles
Job ID
2017-1916
Category
Administrative/Clerical
Type
Regular Full-Time

Overview

Our network of offices servicing California and Washington means West Coast Dental is continuously looking for talented individuals to join our rapidly growing team. The variety of opportunities includes corporate, clinical, and field office positions.

 

If you enjoy Welcoming, Communicating, and Delivering best practices, then West Coast Dental has the right career path for you!

 

Welcome to West Coast Dental!

Responsibilities

As an integral part of the Grievance and Appeals Department, the (A & G) Appeal & Grievance Coordinator lends their support in processing member-related grievances and appeals across West Coast Dental various lines of business. Process includes gathering, documenting, tracking, and pursuing resolution of complaints in accordance with regulatory and organizational guidelines (Peer Review Committee).

 

  • Logs and tracks verbal or written member grievances and appeals.
  • Conducts relevant research into complaints and collaborates, coordinates and communicates with the various departments as well as external entities to collect additional information as necessary.
  • Maintains a current knowledge of company products, policies and procedures with the ability to relate acquired knowledge in a clear, concise and understandable manner to patients, providers, internal staff and external entities.
  • Ensures grievances and appeals are handled and resolved in compliance with timeliness requirements, and at the highest standards for accuracy.
  • Prepares, generates, and mails letters, forms, and other related notices.
  • Maintains confidentiality of all protected health information in accordance with state, federal, and corporate guidelines.
  • Performs other duties as assigned

Qualifications

Education

High school diploma or equivalent required. Associate’s Degree preferred

Experience

Minimum two years of experience in customer service in a health service environment. Previous experience in Managed Care grievances/appeals process or department preferred, dental experience a plus. Strong communication, organizational, critical thinking, and problem solving skills.

West Coast Dental offers:

  • Sick Pay
  • Holiday Pay
  • Vacation Pay
  • Medical (including prescriptions)
  • Vision insurance
  • Comprehensive dental benefit
  • Voluntary supplemental insurance for life, disability, critical illness, cancer, gap and accident
  • Continuing education
  • Advancement opportunities
  • 401 (k) plan  
  • Referral bonus incentive programs
  • Flexible Spending Accounts (Health Care & Dependent Care)

 

We are proud to be an EEO/AA employer M/F/D/V.

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