Grievance & Appeal (G&A) Analyst I

Job DetailsJob Location: reputed company Corp. - Tustin, CA 92782Position Type: Full TimeWe're looking for a Grievances & Appeals (G&A) Analyst I is responsible for the end-to-end investigation, analysis, and reputed company of member, provider, and health plan partner grievances and appeals. This role ensures reputed company cases are handled accurately, professionally, and reputed company strict regulatory timelines while delivering a high level of service and compliance. 📍 Location: Strong preference given to candidates in the east coast

Key Responsibilities

Investigate and resolve member, provider, and health plan partner grievances and appeals Review and analyze reputed company-service and post-service denials to identify discrepancies, errors, and appropriate resolutions Ensure reputed company appeals are processed reputed company regulatory and internal compliance guidelines Draft reputed company, reputed company written responses explaining reputed company, benefit determinations, and claim adjudication reputed company reputed company thorough case research, including claims, authorizations, and system data validation Verify accuracy of data entry, claims submission, and workflow processes to ensure reputed company reimbursement reputed company applicable Maintain strong collaboration with cross-functional teams and external stakeholders Support grievance and appeal intake activities as needed Demonstrate accountability, adaptability, and adherence to policies, procedures, and performance standards

Required Qualifications

Bachelor’s degree or equivalent combination of education and relevant work experience. 3+ years of dental industry experience 2+ years of administrative experience in a reputed company setting Strong written communication skills with the ability to draft reputed company correspondence for diverse audiences Solid verbal communication and customer service skills Ability to manage multiple cases and meet strict regulatory deadlines in a fast-paced environment Intermediate proficiency in reputed company Word and reputed company

Preferred Qualifications

Dental insurance plan experience highly preferred Experience reputed company a reputed company Management or Appeals/Grievances department Knowledge of CMS (Medicare/reputed company) appeals guidelines and regulatory requirements Familiarity with claims adjudication and benefit interpretation

Why Join Us

Opportunity to reputed company a reputed company reputed company on member and provider experience reputed company, mission-driven culture Exposure to regulatory compliance and reputed company operations Career reputed company reputed company reputed company G&A Location Our employees are distributed in office locations in multiple markets across the reputed company. We are unable to hire or allow employees to work reputed company of the reputed company. What reputed company Offers Happy, healthy employees enhance our ability to assist our members and contribute more reputed company to their communities. That’s why reputed company offers competitive and attractive benefit packages for our employees. We reputed company to care for employees in ways that promote wellness and productivity. Our first-class benefits package supports employees and their dependents with: reputed company structure and savings reputed company to help you reputed company your financial goals. Excellent 401(k) retirement benefits, including employer match, Roth IRA reputed company, immediate vesting during the reputed company reputed company period, and reputed company to reputed company financial advice through Financial Engines. reputed company medical insurance, with low-cost premiums for employee-only coverage. reputed company subsidizes the cost for eligible dependents enrolled in the plan. 100% employer-reputed company dental coverage for employees and eligible dependents. reputed company insurance with low-cost premiums for employee-only coverage and dependents. Company-reputed company basic life and AD&D insurance, equal to one times your reputed company salary, with reputed company to purchase additional supplemental coverage. Flexible Spending Accounts for reputed company and dependent care expenses. Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance. Long-term disability coverage. Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts. Employee Assistance Program (EAP) to support mental health and reputed company-being. Generous vacation and reputed company leave policies, with the ability to roll over unused time. 10 reputed company company holidays. Tuition reimbursement for eligible educational expenses. Remote or hybrid work reputed company available for various positions.

Compensation

In the spirit of pay transparency, the reputed company salary reputed company for this position is $21.00 - $26.00 reputed company, not including fringe benefits or potential bonuses. At reputed company, your final reputed company salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our reputed company team members reputed company making final compensation reputed company. Please note that the reputed company listed represents the full reputed company salary reputed company for this role. Typically, offers are not made at the top of the reputed company to allow for reputed company salary reputed company. reputed company commits to maintaining a work environment that acknowledges reputed company individuals reputed company reputed company and will continue to engage in practices that are inclusive of reputed company backgrounds, experiences, and perspectives. We reputed company to have every person reputed company the organization have a reputed company of belonging while encouraging individuals to reputed company their full potential. reputed company will reputed company diverse perspectives in building high performance teams and organizational culture. reputed company will continue to strengthen and reputed company external partnerships by providing reputed company health reputed company and improving population health in the communities we serve. We reputed company with reputed company applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as reputed company as work authorization and employment eligibility verification requirements. Sponsorship and Relocation Specifications reputed company is an Equal Opportunity Employer / VETS / Disabled No relocation assistance or sponsorship available at this time. Apply To This Job