Location: Camp Hill,PA, USA
This Triage Coordinator will be responsible for the beginning-to-end process of receiving, reviewing, and assigning appropriate cases into the G&A system of record. This position will act as a G&A subject matter expert for all lines of business and gate items that do not belong in the G&A Department. This role partners with various departments to educate and work towards preventing non-G&A items from coming to the department. This is in accordance with the standards and requirements established by various Regulators. Examples include but are not limited to: DMHC, Federal and State Exchanges, CMS.
* Coordinates and manages the appropriate intake and creation of new and existing cases, while identifying the priority of each case based on an initial regulatory and case type analysis.
* Assigns each case to the appropriate team for timely and accurate processing.
* Inputs cases received within 24 hours to 2 business days and due to time sensitivity, some evening, weekend, and holiday work may be required.
* Ensures each new case has all the required elements for processing.
* Collaborates with the assigned G&A Representative or Specialist to ensure cases are acknowledged and responded to correctly, accurately, and within set service level standards.
* Performs initial analysis of case to determine escalation pathway and communications in G&A system of record.
* Categorizes grievances and appeals into appropriate classification for accurate regulatory reporting.
* Performs initial analysis and investigation through various appropriate channels and assesses for appropriate assignment of work
* Leads/coaches the G&A specialists and representatives in response to customer issues, complex inquiries, and difficult situations.
* Writes and manages outbound documents, correspondence, and reports in required time frames.
* 1+ years of experience w/High School
* Experience in customer service, provider service, health service, or dental in a managed care or health care environment handling escalated or complex issues. A minimum of 3 years experience within Grievances and Appeals.
* Knowledge of health plan benefits, processes, and operations
* Intermediate or advanced computer literacy skills
* Strong organizational, time management, and written and oral communication skills
* Detail-oriented with the ability to conduct research and identify steps required to resolve issues and follow through to completion
* Ability to be resourceful and enjoy solving complicated problems to get to the root cause
Base Pay Information
The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity.
Pay Grade 15. $40,500 - $84,800