Delta Dental is looking for a dedicated Appeals Specialist to join our team. This hybrid role requires the employee to live within a reasonable distance of our Alpharetta, GA office and be available to come in as needed.
As an Appeals Specialist, you will play a key role in resolving priority inquiries, disputes, appeals, and grievances from members and providers, ensuring timely and accurate responses that align with our commitment to exceptional customer service.
Responsibilities:
• Investigate and resolve appeals, grievances, and inquiries by communicating with members, providers, clients, and internal departments.
• Enter denial and appeal requests into the system and prepare documentation for review.
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• Conduct in-depth research using available systems and resources.
• Ensure appeals are handled promptly and in compliance with State, Federal, and Delta Dental guidelines.
• Request and document detailed invoices for research purposes.
• Draft clear and accurate appeal responses and generate administrative appeal letters.
• Collaborate with other departments to resolve complex issues efficiently.
Qualifications:
• High school diploma or GED required.
• At least 1 year of experience in inventory management.
• Minimum 1 year of experience in healthcare or a related field, with a focus on appeals.
• Proficient in Microsoft Office, especially Excel (pivot tables and formulas).
• Strong written and verbal communication skills.
• Excellent attention to detail and critical thinking skills.
• Proven problem-solving abilities with a resourceful approach to issue resolution.
• Passionate about enhancing the healthcare experience for our members.
• Energized by helping others and making a positive impact.
• Work Schedule: 8 a.m. to 4:45 p.m., Monday through Friday.
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. $39,000 - $73,200
Additional Information:
Behind the smile! We are dedicated to safeguarding the health and financial stability of our employees and their loved ones. This commitment extends beyond the workplace to foster personal growth and holistic wellbeing. Our life-changing rewards package includes:
- Competitive base and incentive pay
- 401(k) with robust matching and non-matching contributions
- Rich medical & pharmacy benefits
- 100% employer-paid dental and vision benefits
- Holistic wellbeing program with deep financial incentives
- Generous paid time off plus 12 paid holidays and your birthday off
- Culture of growth and learning: career development; tuition reimbursement; recognition program
- Family support: adoption assistance, fertility treatment, child, elder & pet care assistance
- Social responsibility and volunteer opportunities
- Employee discount program
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.
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