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 Coordinator.

The Appeal and Grievance Coordinator is responsible for timely resolution and response to appeals and grievances in accordance with the established appeal and complaint procedures.

• Coordinate research, resolution and response to appeals and grievances initiated by members and providers.
• Interact with members, contracted providers and various departments to investigate and respond to appeals and grievances.
• Interpret written inquiries and complaints and identify steps required to resolve customer concerns.
• Summarize quality complaints and presents essential information for review by the Director of Quality, Dental Director and/or Quality Assurance Committee, as appropriate.
• Serve as key contact for internal and external customers regarding appeal and grievance case files assigned.
• Conduct root-cause analysis related to trends observed from appeals and grievances data
• Support the Director of Quality with satisfying requests relating to appeals and grievances data during regulatory audits.
• Demonstrate and maintain a positive and open-minded demeanor and welcoming approach when engaging with team members and internal partners.
• Perform other duties as necessary.

The minimum qualifications for the ideal candidate include: 

• Detail-oriented with the ability to conduct research. Attention to detail is critical.
• Excellent verbal and written communication skills. Ability to demonstrate excellent English language proficiency skills and put skills into practice: spelling, grammar, punctuation.
• Ability to manage own work, multi-task, and prioritize.
• Highly organized, deadline oriented, and quality focused
• Ability to work collaboratively and effectively across multiple departments.
• Knowledge of dental benefits and dental terminology.
• 2+ years of experience in customer service within a dental, medical or Managed Care industry resolving escalated or complex issues.
• Basic to Intermediate experience with Microsoft Office Suite.

Work Environment:

This role routinely uses standard office equipment such as laptops and smart phones.

Physical Demands:

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• While performing the duties of this job, the employee is regularly required to talk or hear.
• The employee frequently is required to use hands to finger, handle or feel; and reach with hands and arms.

Other:

• This is a full-time position, Monday through Friday and hours of work may fall between 7:30 a.m. and 6 p.m.