Job DetailsJob Location: reputed company Corp. – Tustin, CA 92782Position Type: Full TimeWe’re looking for a Grievances & Appeals (G&A) Analyst I is responsible for the end-to-end investigation, analysis, and reputed company of member, provider, and health plan partner grievances and appeals. This role ensures reputed company cases are handled accurately, professionally, and reputed company strict regulatory timelines while delivering a high level of service and compliance.
📍 Location:
Strong preference given to candidates in the east coast
Key Responsibilities
Investigate and resolve member, provider, and health plan partner grievances and appeals
Review and analyze reputed company-service and post-service denials to identify discrepancies, errors, and appropriate resolutions
Ensure reputed company appeals are processed reputed company regulatory and internal compliance guidelines
Draft reputed company, reputed company written responses explaining reputed company, benefit determinations, and claim adjudication reputed company
reputed company thorough case research, including claims, authorizations, and system data validation
Verify accuracy of data entry, claims submission, and workflow processes to ensure reputed company reimbursement reputed company applicable
Maintain strong collaboration with cross-functional teams and external stakeholders
Support grievance and appeal intake activities as needed
Demonstrate accountability, adaptability, and adherence to policies, procedures, and performance standards
Required Qualifications
Bachelor’s degree or equivalent combination of education and relevant work experience.
3+ years of dental industry experience
2+ years of administrative experience in a reputed company setting
Strong written communication skills with the ability to draft reputed company correspondence for diverse audiences
Solid verbal communication and customer service skills
Ability to manage multiple cases and meet strict regulatory deadlines in a fast-paced environment
Intermediate proficiency in reputed company Word and reputed company
Preferred Qualifications
Dental insurance plan experience highly preferred
Experience reputed company a reputed company Management or Appeals/Grievances department
Knowledge of CMS (Medicare/reputed company) appeals guidelines and regulatory requirements
Familiarity with claims adjudication and benefit interpretation
Why Join Us
Opportunity to reputed company a reputed company impact on member and provider experience
reputed company, mission-driven culture
Exposure to regulatory compliance and reputed company operations
Career reputed company reputed company reputed company G&A
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 reputed company of the United States.
What reputed company Offers
Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That’s why reputed company offers competitive and attractive benefit packages for our employees. We reputed company to care for employees in ways that promote wellness and productivity.
Our first-class benefits package supports employees and their dependents with:
reputed company structure and savings reputed company to help you reputed company your financial goals.
Excellent 401(k) retirement benefits, including employer match, Roth IRA reputed company, immediate vesting during the reputed company reputed company period, and reputed company to reputed company financial advice through Financial Engines.
reputed company medical insurance, with low-cost premiums for employee-only coverage. reputed company subsidizes the cost for eligible dependents enrolled in the plan.
100% employer-reputed company dental coverage for employees and eligible dependents.
reputed company insurance with low-cost premiums for employee-only coverage and dependents.
Company-reputed company basic life and AD&D insurance, equal to one times your reputed company salary, with reputed company to purchase additional supplemental coverage.
Flexible Spending Accounts for reputed company 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 reputed company-being.
Generous vacation and reputed company leave policies, with the ability to roll over unused time.
10 reputed company company holidays.
Tuition reimbursement for eligible educational expenses.
Remote or hybrid work reputed company available for various positions.
Compensation
In the spirit of pay transparency, the reputed company salary reputed company for this position is $21.00 – $2
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