Job descriptionAt 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 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:
- Processes and/or adjudicates claims or treatment authorization requests that require professional review; reviews supporting documentation and adjudicate by applying dental standards.
- Identifies when additional information is necessary to make a claim or prior authorization determination and collaborate with internal and external parties to gather information where appropriate.
- Responds to inquiries from internal and/or external stakeholders regarding claim or prior authorization requests.
- Utilizes best practices in identification of potential Fraud, Waste, and Abuse (FWA) issues and report any identified issues to the appropriate party for resolution.
- Processes requests for re-evaluation.
- May review and analyze documentation related to patient quality-of-care complaints, state hearings, first level appeals, audits, Conlan cases, and maintain logs of resolved grievances as needed.
- Conducts or assist in developing seminars or training programs as needed.
- This list is not all-inclusive and you are expected to perform other duties as requested or assigned
What we look for:
- A DDS or DMD degree from an accredited dental school.
- Active and unencumbered license in good standing with the Dental Licensing Board of California.
- A minimum of 10 years of private dentistry practice experience.
- 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.
Benefits and perks:
- 12 days starting vacation, 12 holidays, 9 sick days and your birthday off!
- Low-cost premium medical insurance options
- 100% paid 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
- Fertility and diabetes benefits
- Employee discount program: AT&T/Verizon, entertainment, travel, and more!
- Culture of learning: career development and tuition reimbursement
- Career growth: we love promoting from within
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: Delta Dental Ins. on Facebook and Instagram, #LifeatDDins on Facebook and Instagram, Twitter, and Delta Dental Ins. on LinkedIn. ABOUT Delta Dental Delta 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.
Delta Dental* has enacted a COVID-19 vaccination policy to protect all employees and the communities we serve due to the ongoing impacts of the COVID-19 pandemic. Accordingly, we require all employees to be fully vaccinated for COVID-19. Are you able to comply with our policy of being fully vaccinated by your start date if an offer is made or have a medical or sincerely held religious exemption for receiving a COVID-19 vaccine? Failure to comply with our policy and submit proof of compliance or receive approval for a valid medical or sincerely held religious belief exemption prior to your start date will nullify any offer of employment extended to you.
- Delta Dental includes: Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, and Delta Dental of New York
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