Dental Network Maintenance and Grievance Coordinator

DELTA DENTAL OF ILLINOIS•Naperville, IL

10d•$24 - $28•Hybrid

About The Position

Delta Dental of Illinois is seeking a Dental Network Maintenance & Grievance Coordinator responsible for coordinating, tracking, and resolving member grievances working with Members, Dentists/Dental Providers, and internal stakeholders. This position is also responsible for maintaining DDIL provider directory for accuracy and facilitate follow up with leads for new provider contracts.

Requirements

Knowledge of dental insurance products
Knowledge of dental claims processing and dental claims system
3-4 years of experience in Provider Relations and/or related experience
Extensive knowledge of dental terminology with an understanding of managed care
Proficiency with Microsoft Office programs

Nice To Haves

Free dental for employees and their dependents

Responsibilities

Acts as Grievance Coordinator for complaints and grievance resolutions.
Assists in handling escalated member and/or provider concerns
Maintain grievance database and provide quarterly reports to VP, Dental Science & Network Strategy.
Provides utilization review, reports and investigations as needed.
In-house and outsourced recruitment/retention support, including but not limited to policy explanation, servicing the dental community and dentist inquiries, identifying and responding to network leads for potential network growth.
Coordinates daily calls to offices verifying the office’s information is accurately reflected in the DDIL provider directory and update as needed.
Responsible for establishing and maintaining provider records in multiple provider databases. This complex process requires cross-checking existing databases and data entry.
Responsible for processing dental network agreements within guidelines, reviewing all applications for thoroughness, and communicates with the offices that fail to complete the application in its entirety.
Provide courteous, professional, and confidential service to dental professionals by telephone, electronic/written or in person regarding network information, rules and regulations, policy and procedures, provider issues, change requests and claim related inquiries.