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Union - Appeals Representative at Delta Dental of California

Posted in Other 30+ days ago.

Location: Rancho Cordova, California





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 is a Union position Grade 5 (V).
The Union Appeals Rep researches and resolves priority inquiries and complaints from enrollees, groups, brokers and other entities. The incumbent complies with the Department of Managed Health Care complaint handling and response time protocols and maintains complaint tracking records to meet regulatory and client requirements.

How you will make an impact:


  • Researches all aspects of complaint/inquiry including group contract provisions, eligibility requirements, provider participation/status and Delta Dental processing policies.

  • Prepares formal written responses to enrollees, groups, brokers, dentists and other entities concerning priority inquiries and complaints.

  • Maintains complaint tracking record, daily turnaround time, document tracking and production count records.

  • Answers telephone inquiries from enrollees and dentists regarding Delta Dental processing policies, grievance process and case resolution.

  • Researches and resolves claim inquiries and complaints.

  • Performs miscellaneous duties as assigned.

What we look for:


  • Dental Assisting Certificate from an accredited dental assisting school and/or 2 years dental office experience or customer service/ claims adjudication experience in an insurance company.

  • High school diploma or GED.

  • Pass Delta Dental's Appeals Representative test.

  • Knowledge of dental terminology/procedures/radiographs.

  • Basic knowledge of HIPAA guidelines.

  • Strong keyboarding skills.

  • Skilled in basic mathematical calculations.

  • Must be able to work occasional overtime as required.

  • Ability to maintain regular/consistent attendance, punctuality and adhere to scheduled shifts.

Benefits and perks:


  • 10 days starting vacation plus 12 holidays and your birthday off!

  • 100% paid medical, 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

  • Employee discount program: AT&T/Verizon, entertainment, travel, and more!

  • Fertility and diabetes benefits

  • Culture of learning: career development and tuition reimbursement

  • Career growth: we love promoting from within

Please note, Delta Dental will not sponsor applicants for work visas for this position.
#LI-JB1
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!
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: @lifeatddins on Facebook and Instagram, @deltadentalins on Twitter, and Delta Dental Ins. on LinkedIn. ABOUT Delta DentalDelta Dental covers more Americans than any other dental benefits provider. Our vision is to motivate and empower every employee so we're all inspired to take exceptional care of our customers, providers and each other. 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, genetics, or any other classification protected by federal or state 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.
As a Federal Contractor, we require all employees to be fully vaccinated for COVID-19. You will be required to provide proof of full vaccination upon hire or obtain approval of a valid medical or sincerely held religious exemption from receiving a COVID-19 vaccine prior to your start date.
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