Supervisor Grievance and Appeals

The Supervisor Grievance & Appeals is responsible for providing leadership, coaching, development, and support to all Grievance and Appeals staff. This position is responsible for ensuring the quality and integrity of the grievance and appeals process. Additionally, this position oversees staff inventory and monitors department turnaround times, follow-up, and compliance to departmental and Delta Dental policies. Lastly, the Supervisor is instrumental in collaborating with and providing feedback to cross-functional business partners to ensure the fulfillment of Delta Dental's commitment to its enrollees and providers.

Responsibilities:

Oversees the day-to-day operations of G&A staff and functions, including adjusting case load assignments, quality inspecting and assessing cases, and leading, developing and coaching staff to ensure departmental goals and expectations are met.

Assumes and maintains responsibility for the hiring, onboarding, and continuous development of Grievance & Appeals staff. Collaborates with the enterprise training, development & learning (TDL) team to regularly assess training needs of the team and develop thorough training curriculum, materials, schedules, and procedures.

Develops and implements performance management and monitoring tools to track adherence to performance guarantees (PGs) and team productivity, timeliness, and overall performance. Validates the integrity and accuracy of Grievance & Appeals reporting.

Ensures consistency and quality in execution across team; holds staff accountable to established policies and effectively communicates client expectations and regulatory requirements.

Collaborates with cross-functional business units to ensure consistent feedback, systemic alignment, and reduction of operational gaps.

Serves as a subject matter expert and resource on complaint and appeal processes, escalated or complex case issues, and system issues related to the research and resolution of grievances, appeals, and provider disputes programs.

Continuously evaluates the needs of the department and recommends changes or solutions to leadership as appropriate.

Establishes departmental work goals and/or quantitative and qualitative standards and monitors progress.

Participates in departmental or enterprise projects and audits as required.

Qualifications:

• 5+ years of experience w/Associate's degree; 0+ years supervisory experience
• 2+ years of experience in grievance and appeals processing
• Strong organizational/time management skills and ability to multi-task while maintaining attention to detail
• Ability to establish and maintain effective interpersonal relationships with all levels of staff, other programs, agencies, and the public
• Excellent written and verbal communication skills, including skill in negotiation
• Analytical, critical thinking, and problem-solving skills
• Demonstrated supervisory, coaching, and training skills
• Knowledge of health care industry issues is preferred
• Knowledge of Delta Dental products, policies, claims, eligibility and underwriting procedures and guidelines
• Intermediate knowledge of Microsoft Office programs, i.e. Word, Excel, Outlook, etc.
• CDA-Certified Dental Assistant preferred
  
  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 19. $63,700 - $133,500

Additional Information:

Behind the smile! We are dedicated to safeguarding the health and financial stability of our employees and their loved ones. This commitment extends beyond the workplace to foster personal growth and holistic wellbeing. Our life-changing rewards package includes:

• 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

Fair Chance Ordinances and Criminal Background Considerations

This position requires that the applicant undergo a background check. Qualified applicants with arrest or conviction records will be considered for employment in accordance with any applicable federal, state or local laws, including, but not limited to, the California Fair Chance Act, the Los Angeles County Fair Chance Ordinance, the City of Los Angeles Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, and/or New York Corrections Law Article 23-A.

#LI-Hybrid

Client-provided location(s): Fair Oaks, CA

Job ID: Delta_Dental-2820

Employment Type: FULL_TIME

Posted: 2025-08-19T23:37:31