New

Medicare and Medicaid Complaint Coordinator - Hybrid Alpharetta

Delta Dental of California
$40,500 - $84,800
dental insurance, paid time off, paid holidays, tuition reimbursement, 401(k), employee discount
United States, California, Rancho Cordova
Jun 30, 2025
JOB DESCRIPTION The Medicare and Medicaid Complaint Coordinator is responsible for managing and responding to complaints initiated by Medicare Advantage Organizations (MAOs) and Medicaid carriers, ensuring a streamlined and timely resolution process. This role involves direct communication with MAOs, internal business partners, and providers, as well as participation in meetings with plans, Account Managers, and cross-functional teams to address concerns effectively. Please note this position is hybrid and requires the employee to report to the Alpharetta office as needed for meaningful in-person events such as town halls, team building, training, volunteering, etc. RESPONSIBILITIES Log, track, and manage inquiries, appeals, and grievances from MAOs and Medicaid carriers. Investigate complaints by collaborating with MAO plans, providers, and internal departments, ensuring thorough information gathering and resolution. Conduct research to identify relevant policies, including plan provisions, Evidence of Coverage (EOC), and regulatory guidelines applicable to appeals and grievances. Request, obtain, and document detailed invoices as necessary to support research and case resolution. Summarize case details and compile necessary clinical documentation for review by the Clinical Review department, working closely with Dental Consultants and clinical staff to address medical or dental-related concerns. Ensure all appeals comply with State, Federal, and Delta Dental quality guidelines, meeting required timelines and resolution standards. Assist in coordinating interdepartmental issue resolution efficiently and effectively. QUALIFICATIONS Ability to work a starting schedule of 8 a.m. to 4:45 p.m. eastern, Monday through Friday. Alternative schedule options may be considered after the training/nesting period based on performance. Experience in customer service, provider services, healthcare, or dental managed care, handling complex or escalated issues in government and commercial insurance. 3 or more years' experience researching and resolving inquiries from State and Federal agencies regarding Medicare and Medicaid complaints. Strong problem-solving and critical-thinking skills, with the ability to analyze cases, identify solutions, and drive them to resolution. Excellent organizational and time management abilities, with keen attention to detail. Basic proficiency in Microsoft Office. Strong verbal and written communication skills, with the ability to engage and collaborate with diverse stakeholders. Excellent ability to thrive in a fast-paced, high-production environment. 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 15. $40,500 - $84,800 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. Important Work Authorization Information 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 fair 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 Ins. is an equal opportunity employer and is committed to providing a professional work environment free from discrimination and harassment. Individuals seeking employment at Delta Dental are considered without regard to race, ethnicity, color, age, sex, religion, national origin, ancestry, pregnancy, sexual orientation, gender identity, gender expression, genetic information, actual or perceived physical or mental disability, registered domestic partner status, caregiver status, marital status, veteran or military status, citizenship status, or any other legally protected category. Delta Dental is committed to providing equal employment opportunities to all employees and applicants for employment. Accordingly, we have adopted and maintain an Equal Employment Opportunity Policy, Harassment-Free Work Environment Policy, and Respectful Workplace policies and will not tolerate violations of these policies. 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 If You Are A Current Employee Click Here* To Apply