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Regulatory Complaint Coordinator

3 months ago

Camp Hill, United States Delta Dental Ins. Full time

**JOB DESCRIPTION**

The Regulatory Complaint Coordinator will respond to complaints initiated by regulatory agencies, work on CMS Plans, and oversee the complaint response process to facilitate timely resolutions and responses. This position will participate in regulatory and group audits, and in the analysis of regulatory complaint drivers.

**This person should live on the eastern time zone (EST).**
- **This role will be posted through Thursday 6/13/24 at 5pm PST.**

**RESPONSIBILITIES**
- Records and resolves all provider and member complaints and inquiries initiated by local, State and Federal regulatory agencies, as well as governmental contracted entities into company tracking system.
- Identifies the root causes of executive complaints and works with the applicable operational departments to implement an appropriate resolution - departments include, but are not limited to: Finance, Enrollment, Claims, Provider Relations & Contracting, Member Services, Medical Management and Product Management.
- Resolves all Center for Medicaid and Medicare member complaints and inquiries.
- Coaches the G&A specialists and coordinators in response to customer issues, complex inquiries, and difficult situations.
- Communicates resolutions to the requesting agency via telephone or written correspondence.
- Assists the department in maintaining, tracking, resolution outcome and following up on all regulatory directives received from governmental agencies.
- Extracts complaints data to identify trends and patterns and performs appropriate analysis and translation of such data.
- Participates in client and regulatory audits.
- Identifies member problems, member education needs and/or trends. Reports this information to G&A leadership and provides recommended resolution based on the analysis of data.
- Stays abreast of new and/or emerging regulatory guidelines, standards, business changes, etc. affecting the member advocacy and/or grievance and appeals process.

**QUALIFICATIONS**
- ** 3+ years of experience** w/High School
- Experience in customer service, provider service, health service, or dental in a managed care or health care environment handling escalated or complex issues in government and commercial lines of business. **A minimum of 3 years experience with researching and resolving inquiries received from State and Federal agencies.**:

- Knowledge of how to research and resolve inquiries received from State and Federal agencies
- Proficient in using MS Office products - specifically using Excel to create pivot tables and formulas
- Strong detail orientation
- Problem solving and critical thinking skills, with the ability to conduct research and identify steps required to resolve issues and follow through to completion
- Strong organizational and time management skills
- Excellent verbal and written communication skills with the ability to engage with a wide variety of audiences

Licenses
- Six Sigma Green Belt Certification. Pref'

Base Pay Information

**ADDITIONAL INFORMATION**

Rewards to make you smile We don't just want to make our customers happy - we want to give our employees a reason to smile, too. Delta Dental's comprehensive benefits package includes:

- Generous paid time off plus 12 holidays and your birthday off
- Low-cost premium medical insurance options
- 100% paid dental and vision insurance
- Generous 401(k) matching and flat contribution
- Social responsibility and volunteer opportunities, including 16 paid volunteer hours annually
- Employee LiveWell program, focusing on overall employee well-being
- Fertility and diabetes benefits
- Employee discount program: AT&T/Verizon, entertainment, travel, and more
- Culture of learning: career development and tuition reimbursement
- Career growth: we love promoting from within

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Please note, Delta Dental will not sponsor applicants for work visas for this position.

LI-Remote

**ABOUT THE TEAM**

At Delta Dental, our success is only as strong as the people who execute it We take enormous pride in being the nation's most recognized and widely-used provider of dental insurance - and we've come this far by living our core values of innovation, excellence, service and trust. Our vision is to motivate and empower every employee so that we're all inspired to take exceptional care of our customers, providers and ourselves. We believe in integrity, accountability, collaboration, and giving every employee equitable opportunity for their voice to be heard and development to be fostered.

If you're excited about the prospect of transforming the future of health care and growing in your career, join our smile revolution

To see some of the smiling faces behind Delta Dental and to learn more about what our values and culture look like in action, connect with us on social media: Delta Dental Ins. on Facebook and Instag