Complaints and Grievances Dental Intake Coordinator

Employer: Guardian Life Insurance

ob Description

This position is responsible to provide intake and distribution of incoming physical mail/email/faxes for the Quality Management (“QM”) and Complaints & Grievances (“C&G”) area. The position requires a high level of attention to detail, the ability to organize and prioritize work based on stringent State specific timeframes, have solid time management skills, analytical skills and be able to negotiate and communicate effectively with both internal Guardian staff and external customers.

As Complains & Grievances Dental Intake Coordinator, you will develop and execute the following key components ensuring a customer centric focus that supports enterprise growth:

• Receive and identify Grievance requests for all Lines of Business and distribute the product specific Complaint packets as necessary to members/patients within 2 business days of receipt as appropriate.
• Identify concerns that require immediate attention (emergency) and shortened State regulatory turnaround times.
• Receive and prepare all incoming complaint packets.
• Compose and ensure accurate Member/Office information is present prior to distribution of Acknowledgement and Request for Records letters for all Complaints/Grievances and Appeals/Disputes within State specific regulatory turnaround times.
• Extract and include pertinent documentation from the Guardian claims system and/or Customer Care call database as necessary.
• Prepare electronic Complaint/Grievance and Appeal/Dispute files and assign to the appropriate Coordinator.
• Prepare and upload to FileNet all incoming Complaint/Grievance and Appeal/Dispute documentation and update the QMP Database with the received date.
• This position is required to identify and document accurate data in the QMP database. The Role must ensure that each members’ concerns are appropriately addressed clearly and concisely. Verification of accurate historical Appeals and Provider Dispute data is extracted from Guardian claim system and documented in the QMP. In addition, Grievance Packets status must be documented in the appropriate systems once sent to the Enrollee.
• Monitor the Complaints & Grievances and Quality Management email inboxes and Quality Management Customer Care call database inboxes. In a timely manner, identify and distribute follow-up requests to the appropriate internal Staff or Department.

You will

• High level attention to detail
• Strong knowledge of Guardian systems, state regulation and timeframes
• Manages multiple tasks with multiple deliverables simultaneously
• Excellent written and oral communication skills are mandatory

Reporting Relationships

This position reports to the Manager, Complaints & Grievances, who in turn, reports to the Assistant Vice President, Group Dental Claims.

Qualifications

You are

The position requires the ability to effectively function in a team environment but also be a self-starter and work with minimal direction making independent decisions under pressure.

You have

• Minimum 2 years of dental plan and customer service experience mandatory
• Strong Microsoft Word, Excel, PowerPoint skills
• College degree preferred or a combination of education and relevant work experience. High School Diploma required.

Location & Vaccination Requirements

• The primary location for this position is remote, with an “at home” work arrangement.
  Covid – 19 vaccinations not required unless you voluntarily visit one of our campus locations or are attending an in-person company sponsored event.

Travel

• No travel required for this role.

Our promise

Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards

We offer

• Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
• Competitive compensation package.
• Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
• Life and disability insurance.
• A great 401(k) with company match.
• Tuition assistance, paid parental leave and backup family care.
• Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
• Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
• Employee Resource Groups that advocate for inclusion and diversity in all that we do.
• Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.

Primary Location: United States
Job: Claims
Schedule: Full-time
Shift: Day Job
Job Type: Standard
Travel: No

APPLY HERE