Full Job Description
At Delta Dental, our strategy is only as strong as the people who execute it! We are hiring individuals that are not just right for today but also for our future. We have built a foundation of high-trust by treating all people with dignity, making and keeping commitments, and consistently striving to do the right thing. Our leaders optimistically share future possibilities to inspire and motivate others toward their full potential. We expect our employees to find ways to embrace positive change, be curious and challenge the status quo, and provide solutions to unmet problems. Joining Delta Dental means joining a culture focused on fostering development, building genuine connections, recognizing each other’s strengths and sharing in successes.
This position is located in our Alpharetta, GA location and is responsible for the review and resolution of patient complaints and grievances; and/or the adjudication of claims or provider audits as applicable.
How you will make an impact:
Reviews and analyzes documentation related to patient complaints.
Corresponds with QA or QM Analysts regarding case analysis and resolution.
Prepares draft responses pertaining to grievances and appeals.
Provides assistance to Supervising Dental Consultants and Legal department in arbitration cases.
Requests refunds from providers.
Maintains logs of resolved complaints.
May act as member of Quality Review Committee for Federal Government Programs.
May provide oversight to the Division Focused Review Program.
What we look for:
A DDS or DMD degree from an accredited dental school.
A minimum of 5 years of private dentistry practice experience.
State of Georgia active and unencumbered license and good standing with the Dental Licensing Board.
Strong organizational/time management skills and multi-tasking abilities.
Detail oriented with analytic and problem-solving abilities.
Customer service, conflict management and dispute resolution skills.
Knowledge of health care industry issues preferred.
Knowledge of Delta Dental products, policies, claims, eligibility and underwriting guidelines.
PC literacy required; MSOffice skills (Outlook, Word, Excel, PowerPoint).
Benefits and perks:
12 days starting vacation plus 11 holidays and your birthday off!
Multiple medical insurance options: 100% paid or low cost premiums
100% paid dental insurance
100% paid vision insurance
Onsite gym and/or gym discount and fitness incentive
Culture of learning: substantial tuition reimbursement to improve your skills
Career growth: we love promoting from within
Strong commitment to work/life balance
Social responsibility and volunteer opportunities
At Delta Dental we:
Promote accountability, integrity and collaboration: Our employees are collaborative, self-aware, and ethical. It is our expectation to do the right thing and follow through on commitments.
Foster professional development: Our employees take ownership of developing themselves and others through coaching, mentoring and providing/being open to constructive feedback and identifying learning opportunities.
Value customers and cultivate positive experiences: Our employees take time to build rapport with customers, while anticipating and exceeding their needs to ensure positive outcomes.
If you think this sounds like you, let’s chat. We would love to tell you more!
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ABOUT Delta Dental
Delta Dental covers more Americans than any other dental benefits provider. As an employee you’ll take part in our mission to become the trusted health partner by collaborating with our communities and employees to reimagine and deliver new possibilities in an ever-changing environment. Our Enterprise Strategy focuses on pillars of Growth and Diversification, supported by the platforms of Culture and People, Process and Technology. Our employees take pride working for a purpose-driven organization and live our values of Trust, Service, Excellence and Innovation.
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 provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. 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.