Grievance & Appeal (G&A) Analyst I

Tooth be told, you will love working at Liberty Dental Plan!

We are seeking a Grievance & Appeals (G&A) Analyst to join our team! Ideal candidates will reside near one of our office locations in Tustin, CA, Las Vegas, NV, Oklahoma City, OK, Uniondale, NY, or Tampa, FL.

Position Hours are Monday - Friday 8:00 AM - 5:00 PM Pacific.

Job Summary Details

• The Grievances and Appeals Analyst I will be responsible for investigating and resolving member, Health Plan Partner-member and network provider grievances and appeals.

• Identify, analyze and research both pre- and post-service denials for both members and providers to identify discrepancies, errors, etc. and to determine appropriate course(s) of action.

• Process all appeals within regulatory guidelines.

• Respond in writing to members and providers, making informed judgements on the proper application of members’ dental plan benefits, accurate adjudication of claims and referrals and other potential issues by conducting timely, thorough investigations of assigned grievances and appeals cases.

• Verify information related to data entry, claims submissions, authorizations and workflow processes to ensure timely reimbursement to members and providers when necessary.

• Demonstrate team-oriented attitude by following directions from Supervisor, interacting well with co- workers, accepting and following work rules and procedures, complying with corporate policies, goals and objectives, accepting constructive feedback and exhibiting initiative and accountability for their work.

• Interface with other internal and external entities, ensuring a positive and professional relationship.

• The Grievances and Appeals Analyst I will also be responsible for occasional intake of all member and provider grievances and appeals.

Education/Experience

• High School or GED required
• 3 years of dental background
• 2 years of office administrative support experience in healthcare

Specific Skills/Knowledge

• Dental Insurance Plan experience and familiarity of dental terminology highly preferred.

• Experience in a Quality Management Department preferred.

• Excellent time management skills are required, along with the ability to meet strict internal and regulatory deadlines, while working independently in a fast-paced environment and maintaining superior work quality.

• Intermediate knowledge in Microsoft Word and Excel.

• Excellent written communication skills, with the ability to draft professional business correspondence directed toward a wide variety of audiences, from laymen to doctors, is required.

• Strong verbal communication and customer service skills, particularly as it relates to processing member and provider grievances and appeals.

• Demonstrate ability to work independently, prioritize workload and maintain strong business relationships.

• Strong working knowledge of applicable laws and regulations, including current appeals guidelines established by the Centers for Medicare and Medicaid Services (CMS), and the ability to research Medicare and Medicaid regulations to ensure compliance and protect the company from sanctions, enforcement actions and penalties.

• Availability to work overtime when required.

Location

Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States. Ideal candidates will reside near one of our office locations in Tustin, CA, Las Vegas, NV, Oklahoma City, OK, Uniondale, NY, or Tampa, FL. Position Hours are Monday - Friday 8:00 AM - 5:00 PM Pacific.

What Liberty Offers

Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That’s why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity.

Our first-class benefits package supports employees and their dependents with:

• Competitive pay structure and savings options to help you reach your financial goals.

• Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.

• Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.

• 100% employer-paid dental coverage for employees and eligible dependents.

• Vision insurance with low-cost premiums for employee-only coverage and dependents.

• Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.

• Flexible Spending Accounts for healthcare and dependent care expenses.

• Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.

• Long-term disability coverage.

• Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts.

• Employee Assistance Program (EAP) to support mental health and well-being.

• Generous vacation and sick leave policies, with the ability to roll over unused time.

• 10 paid company holidays.

• Tuition reimbursement for eligible educational expenses.

• Remote or hybrid work options available for various positions.

Compensation

In the spirit of pay transparency, the base hourly range for this position is $21.00 - $26.00, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions.

Please note that the range listed represents the full base hourly range for this role. Typically, offers are not made at the top of the range to allow for future salary growth.

Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture. 

Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve. 

We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.

Sponsorship and Relocation Specifications

Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled.

No relocation assistance or sponsorship available at this time.