Reference #: 1023\
This Triage Coordinator will be responsible for the beginning-to-end process of receiving, reviewing, and assigning appropriate cases into the G&A system of record. This position will act as a G&A subject matter expert for all lines of business and \"gate\" items that do not belong in the G&A Department. This role partners with various departments to educate and work towards preventing non-G&A items from coming to the department. This is in accordance with the standards and requirements established by various Regulators. Examples include but are not limited to: DMHC, Federal and State Exchanges, CMS.
Coordinates and manages the appropriate intake and creation of new and existing cases, while identifying the priority of each case based on an initial regulatory and case type analysis.\
Assigns each case to the appropriate team for timely and accurate processing.\
Inputs cases received within 24 hours to 2 business days and due to time sensitivity, some evening, weekend, and holiday work may be required.\
Ensures each new case has all the required elements for processing.\
Collaborates with the assigned G&A Representative or Specialist to ensure cases are acknowledged and responded to correctly, accurately, and within set service level standards.\
Performs initial analysis of case to determine escalation pathway and communications in G&A system of record.\
Categorizes grievances and appeals into appropriate classification for accurate regulatory reporting.\
Performs initial analysis and investigation through various appropriate channels and assesses for appropriate assignment of work\
Leads/coaches the G&A specialists and representatives in response to customer issues, complex inquiries, and difficult situations.\
Writes and manages outbound documents, correspondence, and reports in required time frames.
1+ years of experience w/High School\
Experience in customer service, provider service, health service, or dental in a managed care or health care environment handling escalated or complex issues. A minimum of 3 years experience within Grievances and Appeals.\
Knowledge of health plan benefits, processes, and operations\
Intermediate or advanced computer literacy skills\
Strong organizational, time management, and written and oral communication skills\
Detail-oriented with the ability to conduct research and identify steps required to resolve issues and follow through to completion\
Ability to be 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. \$41,000 - \$83,200
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:
Generous paid time off plus 12 holidays and your birthday off!\
Low-cost premium medical insurance options\
100% paid dental and vision insurance\
Generous 401(k) matching and flat contribution\
Social responsibility and volunteer opportunities, including 16 paid volunteer hours annually\
Employee LiveWell program, focusing on overall employee well-being\
Fertility and diabetes benefits\
Employee discount program: AT&T/Verizon, entertainment, travel, and more!\
Culture of learning: career development and tuition reimbursement\
Career growth: we love promoting from within\
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arr st and conviction records.
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 and #LifeatDDins on and , Delta Dental Ins. on and Delta Dental Ins. on .
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 Den