Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Dominion National at the time of posting and may be modified in the future.

Dominion National offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.

Dominion National, a rapidly growing and leading provider of dental and vision benefits, has an exciting opportunity for an experienced Appeal and Grievance Intake Specialist.

The Grievance and Appeal Intake Specialist supports the Appeals and Grievance (A&G) function by handling all administrative functions of the A&G process including intake, logging, tracking and status follow-up of all appeal and grievance requests. Work involves a review of recorded calls relating to appeals and grievances and prepares written transcripts, as appropriate. Performs other duties as assigned.

Responsibilities and Qualifications

Effectively routes intake/triage for fulfillment, independently evaluates information to determine correct categorization, and performs timely data entry to support follow-up inquiries received in our Service Center.
Tracks all open A&G files to ensure that responses are completed within the timeframe required by alliance performance requirements, law, regulation, policy or other requirement.
Assists with the communication of A&G determinations by preparing template letters for members/providers, prepare weekly department activity reports and monthly production reporting, and scan A&G files for record retention.
Identifies potential issues when preparing and reviewing reports for discussion with department leadership.
Creates and maintains electronic and hard copy paper files in accordance with all regulatory requirements.
Perform other duties as assigned.

Skills:

Self-directed and strong organizational skills to meet departmental goals with minimal supervision
Ability to clearly interpret written inquiries and complaints and produce written documents.
Able to demonstrate excellent business writing and comprehension skills to include but not limited to spelling, grammar, punctuation.

Knowledge:

Strong verbal communication skills.
Demonstrated knowledge of Microsoft Office Suite.

Experience:

Minimum 2+ years of experience in customer service within a dental, medical or Managed Care industry.

Education and Certifications:

High school diploma or equivalent.

Physical Demands:

While performing the duties of this job, the employee is regularly required to talk or hear.
The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.

Dominion National

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Appeal and Grievance Intake Specialist