Delta Dental of Arizona, the state’s #1 dental and vision insurance company, is looking for a conscientious, patient, team-oriented individual with a sharp eye for detail to join our Compliance team.

Reporting to the Appeals and Grievances Supervisor, the Appeals and Grievances Analyst is responsible for claims research/compliance determinations, appeals, grievances, and complaint review and processing.  They also work closely with claims, sales, and other departments to ensure proper benefits are applied.

The ideal candidate thoroughly understands insurance laws and regulations, dental terminology, and has experience reading benefit plans.

About You

You’ve got a few years of experience under your belt working in or with insurance, the dental field or handling appeals and grievances. Despite the short work experience, there is a long list of achieved objectives in your wake. Goals get crossed off your to-do list with thorough and efficient execution. You take a great deal of pride in your reliability, and you avoid careless risk-taking.  Repetitive work doesn’t bother you; it just gives you an opportunity to perfect your method.  

Although you’re pretty analytical, you’ve also got solid people and relationship-building skills. You’re a cooperative, helpful, and supportive team player. You’ve quickly been able to establish yourself as a consistent performer who gets the job done without a lot of drama. 

If this sounds like you, please read on!

Essential Functions

· Research incoming appeals, grievances and complaints, including consideration and reconsideration requests, to properly identify and categorize as processed claims (grievances), denied services (appeals or self-funded (ASO) group requests) or complaints

· Collect all appropriate data and information, and process for clinical or contract consideration as appropriate. 

· Coordinate case review with dental consultants.

· Coordinate timely handling and resolution responses for high volume of appeals and grievances within various regulatory and contractual timelines

· Reconcile across systems to ensure that all member appeals and grievance are logged and tracked.

· Direct external independent reviews to the appropriate independent review organization (IRO) 

· Document records in accordance with DOI guidance requirements

· Prepare and manage all monthly and quarterly customer and internal reporting

· Communicate effectively with other departments such as Claims and Customer Service, Billing & Eligibility, Marketing and Professional Relations to ensure complete and fair reviews of complaints, grievances and appeals

• High school diploma or equivalent required
• 2-4 years of related experience
• Knowledge of insurance laws and regulations
• Ability to read and understand benefit plans
• Familiarity with dental terminology 
• Thorough understanding of relevant State and Federal laws, DDAZ regulations and group policies and procedures
• Solid analytical and problem-solving skills
• Excellent verbal and written communication skills
• Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint

About Us

Delta Dental of Arizona’s vision is simple: healthier lives for everyone. That’s why we’ve made it our mission to create a path to better health and wellness. We’re transforming from a single line insurance company to a multi-line health and wellness organization with a foundation that has awarded millions in grants to non-profits who care for our most vulnerable residents by offering dignity and hope.
 

Our employees enjoy competitive compensation and comprehensive benefits, including medical, dental, vision, 401(k), student loan assistance, six weeks of paid parental leave, volunteer PTO, and a culture that embraces collaboration, service, integrity, and inclusion.  At about 150 employees, we cultivate a work community where all employees are known by name, and everyone’s contributions are visible, noticed, and celebrated. 

The starting pay for this role ranges from $21.39 - $26.97 depending on factors such as years of experience.
 

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification form upon hire.