JOB DESCRIPTION
*Please note that the Triage Coordinator role is a hybrid position that requires the employee to come into the office as needed and live within a reasonable distance of our Camp Hill, PA office.
The Triage Coordinator is responsible for managing the end-to-end process of receiving, reviewing, and assigning cases in the Grievance and Appeals (G&A) system of record. As a subject matter expert in G&A, this role ensures that only relevant items are processed by the G&A department while preventing non-G&A items from entering the workflow. The Triage Coordinator will collaborate with various departments to educate and enforce these standards, which align with requirements established by regulatory bodies, including Department of Managed Health Care (DMHC), Federal and State Exchanges, and Centers for Medicare and Medicaid Services (CMS).
RESPONSIBILITIES
Case Management: Coordinate and manage the intake and creation of new and existing cases, identifying the priority of each case based on initial regulatory and case type analysis.
Assignment: Assign cases to the appropriate team for timely and accurate processing.
Data Entry: Input cases within 24 hours to 2 business days; due to time sensitivity, some evening, weekend, and holiday work may be required.
Quality Assurance: Ensure each case has all required elements for accurate processing.
Collaboration: Work closely with G&A Representatives and Specialists to ensure cases are acknowledged and responded to correctly, accurately, and within established service level standards.
Analysis: Perform initial analysis to determine the escalation pathway and communications in the G&A system of record.
Classification: Categorize grievances and appeals accurately for regulatory reporting.
Investigation: Conduct initial analysis and investigation through appropriate channels to assign work correctly.
Leadership: Lead and coach G&A Specialists and Representatives in handling customer issues, complex inquiries, and difficult situations.
Documentation: Write and manage outbound documents, correspondence, and reports within required time frames.
QUALIFICATIONS
Experience: Minimum of 1 year with a High School diploma. At least 3 years of experience within Grievances and Appeals in a managed care or healthcare environment, handling escalated or complex issues.
Knowledge: Familiarity with health plan benefits, processes, and operations.
Skills: Intermediate to advanced computer literacy. Strong organizational, time management, and communication skills, both written and oral.
Attention to Detail: Ability to conduct research, identify steps required to resolve issues, and follow through to completion.
Problem-Solving: Resourceful and adept at solving complicated problems to identify and address root causes.
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. $41,000 - $83,200
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
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-Hybrid
ABOUT THE TEAM
At Delta Dental, we're behind millions of smiles and counting. For over 68 years, we've served our communities by increasing access to affordable, quality care - but that commitment to care extends beyond the people we serve, to the dedicated employees who make those smiles genuine. We've come this far by building equitable programs that offer opportunities for advancement, create meaningful connections and improve the lives of our employees and their families. Because we know that when we take exceptional care of each other, we can make a positive impact for all.
We champion an inspirational workplace through our commitment to trust, service, excellence and innovation. Joining us means working for a company that offers stability and balance, opportunities for leadership at all levels, and a work environment focused on teamwork and camaraderie.
Discover the smiling faces behind Delta Dental and experience our values and culture in action by connecting with us on social media. Follow Delta Dental Ins. on Facebook and Instagram, #LifeatDDins on Facebook and Instagram, Delta Dental Ins. on Twitter and Delta Dental Ins. on LinkedIn. If you've got an appetite for innovation and want to be a part of a team that's transforming the future of health care, join us!
Since 1955, we have offered comprehensive, high-quality oral health care benefits to millions of enrollees and built the strongest network of dental providers in the country. The Delta Dental of California network includes affiliates Delta Dental Insurance Company; Delta Dental of Pennsylvania; Delta Dental of New York, Inc.; Delta Dental of the District of Columbia; Delta Dental of Delaware, Inc.; and Delta Dental of West Virginia, providing dental benefits to more than 31 million people across 15 states, the District of Columbia, Puerto Rico and the Virgin Islands.
The company and its affiliates are part of Delta Dental Plans Association (DDPA), a not-for-profit national association based in Oak Brook, Illinois. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories. We offer vision coverage through DeltaVision in 15 states and the District of Columbia. Collectively, we deliver benefits to more Americans than any other dental insurance company.
Delta Dental is an equal opportunity employer. We are committed to building and maintaining a diverse and inclusive workplace for all employees. Applicants will not be discriminated against because of race, color, religion, creed, national origin, ancestry, citizenship status, sex (including pregnancy), sexual orientation, gender or identity expression, age, disability, marital status, medical status, veteran status or any other status protected under federal, state, or local law. In addition to federal law requirements, Delta Dental complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Unfortunately, our Delta Dental Enterprise is unable to hire individuals residing in Alaska, North Dakota, Nebraska, Hawaii, Oklahoma, Vermont, Maine, West Virginia, New Hampshire, Wyoming, Puerto Rico, District of Columbia (Washington D.C.) or other US Territories at this time.
Proof of eligibility to work in the United States must be provided if selected for hire.
*Delta Dental includes: Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, and Delta Dental of New York

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Triage Coordinator