Appeals Specialist - Alpharetta, GA

*Please note that the Appeals Specialist role is a hybrid position that requires the employee to come in the office as needed and reside within a reasonable distance of our Alpharetta, GA office.

Delta Dental is seeking a dedicated Appeals Specialist to join our team. As an Appeals Specialist, you will be responsible for researching, resolving, and processing priority inquiries, disputes, appeals, and grievances from members and providers. You will ensure that all requests are handled within specified timeframes, contributing to our commitment to exceptional customer service.

Responsibilities:

• Research and resolve inquiries, appeals, and grievances by communicating directly with members, providers, clients, and internal departments.
• Enter denials and appeal requests into the information system, preparing documentation for further review.
• Utilize systems and available resources to conduct thorough research on issues.
• Ensure timeliness and appropriateness of administrative appeals according to State, Federal, and Delta Dental Healthcare guidelines.
• Request, obtain, and document detailed invoices as needed for research purposes.
• Determine appropriate language and prepare responses to appeals.
• Generate and mail administrative appeal letters.
• Coordinate problem-solving efforts for interdepartmental issues efficiently and timely.

• High school diploma or GED required.
• 1+ years of inventory management experience.
• 1+ years of experience in healthcare or a related field with a focus on appeals.
• Proficient in MS Office, especially Excel (pivot tables and formulas).
• Excellent written and verbal communication skills.
• Strong attention to detail.
• Problem-solving and critical thinking skills, with the ability to conduct research and follow through on issue resolution.
• Passionate about improving the healthcare experience for our members.
• Energized by helping people and seeing the positive impact of your efforts.
• Resourceful and enjoy solving complicated problems to get to the root cause.

• Competitive base and incentive pay
• 401(k) with robust matching and non-matching contributions
• Rich medical & pharmacy benefits
• 100% employer-paid dental and vision benefits
• Holistic wellbeing program with deep financial incentives
• Generous paid time off plus 12 paid holidays and your birthday off
• Culture of growth and learning: career development; tuition reimbursement; recognition program
• Family support: adoption assistance, fertility treatment, child, elder & pet care assistance
• Social responsibility and volunteer opportunities
• Employee discount program