Dental Appeals and Grievances Coordinator

JOB DESCRIPTION

An employer is looking for a remote Appeals & Grievances Coordinator that will be responsible for managing and resolving appeals and grievances related to dental insurance claims. This role requires strong analytical and communication skills, attention to detail, and the ability to work independently in a remote environment while collaborating with internal teams and external stakeholders.

Key Responsibilities

• Review, research, and process appeals and grievances in compliance with company policies and regulatory requirements.
• Draft clear, professional written responses and documentation for appeals and grievances.
• Utilize Microsoft Word, Excel, Adobe, and Outlook for reporting, documentation, and communication.
• Apply critical thinking to analyze complex cases and identify appropriate resolutions.
• Communicate effectively with members, providers, and internal departments to gather necessary information. - Maintain accurate records and ensure timely follow-up on all cases. - Set up and manage remote workstation; troubleshoot and engage with IT support as needed.

REQUIRED SKILLS AND EXPERIENCE