Grievance & Appeal (G&A) Analyst I

Liberty Dental Plan Careers•Tustin, CA

3d•$21 - $26•Hybrid

About The Position

The Grievances & Appeals (G&A) Analyst I is responsible for the end-to-end investigation, analysis, and resolution of member, provider, and health plan partner grievances and appeals. This role ensures all cases are handled accurately, professionally, and within strict regulatory timelines while delivering a high level of service and compliance.

Requirements

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 healthcare setting
Strong written communication skills with the ability to draft professional 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 Microsoft Word and Excel

Nice To Haves

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

Responsibilities

Investigate and resolve member, provider, and health plan partner grievances and appeals
Review and analyze pre-service and post-service denials to identify discrepancies, errors, and appropriate resolutions
Ensure all appeals are processed within regulatory and internal compliance guidelines
Draft clear, professional written responses explaining decisions, benefit determinations, and claim adjudication outcomes
Perform thorough case research, including claims, authorizations, and system data validation
Verify accuracy of data entry, claims submission, and workflow processes to ensure proper reimbursement when 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

Benefits

Competitive pay structure
Savings options
Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.
Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.
100% employer-paid dental coverage for employees and eligible dependents.
Vision insurance with low-cost premiums for employee-only coverage and dependents.
Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.
Flexible Spending Accounts for healthcare 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 well-being.
Generous vacation and sick leave policies, with the ability to roll over unused time.
10 paid company holidays.
Tuition reimbursement for eligible educational expenses.
Remote or hybrid work options available for various positions.