Grievance & Appeal (G&A) Analyst I

Grievance & Appeal (G&A) Analyst I

Fully Remote Liberty Dental Plan Corp. - Tustin, CA 92782

Overview

Position Type Full Time

Description

We're looking for a Grievances & Appeals (G&A) Analyst I 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.

Key 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

Required Qualifications

• 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

Preferred Qualifications

• 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

Why Join Us

• Opportunity to make a direct impact on member and provider experience
• Collaborative, mission-driven culture
• Exposure to regulatory compliance and healthcare operations
• Career growth pathways within G&A

Qualifications

Location

Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.

What Liberty Offers

Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That's why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity.

Our first-class benefits package supports employees and their dependents with:

• Competitive pay structure and savings options to help you reach your financial goals.
• 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.

Compensation

In the spirit of pay transparency, the base salary range for this position is $21.00 - $26.00 hourly, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions.

Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture.

Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve.

We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.

Sponsorship and Relocation Specifications

Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled

No relocation assistance or sponsorship available at this time.