C & G Specialist (Mequon, WI)
December 20, 2012
DentaQuest is looking to hire a Complaints and Grievances Specialist for the organization. The Complaints and Grievances Specialist is responsible to coordinate resolution for Member and Provider Complaints/Appeals/Grievances/Fair Hearings. This is done by documenting and maintaining the case in the assigned database. At times, it may be necessary to contact the Member to gather additional information or to contact the Provider or Provider’s Office to request additional information, interview dental office staff, or request copies of dental records. It may also be necessary to coordinate efforts with internal staff to resolve cases. These areas may include Utilization Review, Provider Relations, Member Services, Client Services, Dental Management, or Utilization Management. All Complaints and Grievances Specialists are expected to meet the guidelines and turnaround times relating to complaints/grievances/appeals set by state regulations and/or Plan contracts.
- 3 – 5 years working with regulatory requirements.
- 1 – 3 years working in direct contact with clients required
- Experience in a managed care environment or provider billing is desired.
- High School Diploma or GED required
- Bachelors Degree desired with emphasis in Communications, Social Work, Health Care, preferred
- Knowledge of general computer software (Excel, MS Word and Access).
- Demonstrated PC skills.
- Typing skills of 40+ words per minute.
- Attention to detail
- Ability to work in a fast paced environment with frequent changes in work priority
- Ability to effectively multi-task
- Effective interpersonal skills
- Excellent written and verbal communication skills.
- Demonstrated analytical skills
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