DentaQuest
Complaints & Grievances Specialist II, DentaQuest (IOWA)
DentaQuest, Des Moines, Iowa, United States, 50319
Complaints & Grievances Specialist II, DentaQuest (IOWA)
Location: Must reside in Iowa.
The opportunity: The Complaints & Grievances Specialist II handles the investigation and resolution of complaints, grievances and member appeals based upon specific regulatory requirements. In addition, responsible for the assembly and preparation of Maximus packets, State Fair Hearing packets as well as coordination and participation in State Fair Hearings. Accountable for daily interaction with assigned market/client contacts, as well as various internal departments. The position ensures that all mandated turnaround times are met as well as required processes and workflows are adhered to.
Responsibilities
Investigate and resolve complaints and grievances in accordance with State and/or Plan guidelines. Ensure all components of the grievance/complaint are researched and addressed.
Prepare State Fair Hearing packets and coordinate scheduling State Fair Hearing reviews.
Assemble necessary information for the plan so they may appropriately investigate member appeals/complaints when we are not delegated.
Monitor shared mailboxes and department e‑mails to ensure cases are properly entered into department tracking system and that requests are acknowledged and resolved timely and accurately. Manage workflow to meet department, Plan, State, and company goals and deadlines.
Comply with and resolve proof of compliance and directives.
Contact involved provider office to obtain information to properly review the case. Document provider's/staff's perception of the member's concerns/issues.
Document all complaints/grievances/appeals in department tracking system.
Handle the following types of complaints/grievances: Member Complaints/Grievances, Member Complaints/Grievances submitted by plan (when DQ is secondary), Provider Complaint, SDOH (State Department of Health) complaints, DOI (Department of Insurance) complaints, BBB (Better Business Bureau) complaints, Executive complaints (complaints addressed to executives of DentaQuest), and any other complaints/grievance submitted as part of the formal grievance process.
Qualifications
High School Diploma or GED required.
1 year of C&G experience with demonstrated success in C&G Specialist I or 2 years' experience in claims, customer service, provider network or another operational function.
Proficient with general computer software including Microsoft Excel, Word and Outlook.
Excellent verbal, written, interpersonal, organizational and communication skills.
Excellent research skills with ability to identify underlying issue(s) not articulated.
Ability to remain calm and focused in a high pressure/high workload environment.
Ability to work in a high stress environment.
Ability to prioritize and organize multiple tasks with tight deadlines.
Ability to remain organized with multiple interruptions.
Ability to work overtime as needed or required to meet business objectives.
Salary and Incentives At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business.
Benefits and Inclusive Employment We encourage applications from qualified individuals from all backgrounds and are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email thebrightside@sunlife.com to request an accommodation.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Posting Information Job Category: Customer Service / Operations
Employment Type: Full-time
Seniority Level: Not Applicable
Posting End Date: 22/01/2026
#J-18808-Ljbffr
The opportunity: The Complaints & Grievances Specialist II handles the investigation and resolution of complaints, grievances and member appeals based upon specific regulatory requirements. In addition, responsible for the assembly and preparation of Maximus packets, State Fair Hearing packets as well as coordination and participation in State Fair Hearings. Accountable for daily interaction with assigned market/client contacts, as well as various internal departments. The position ensures that all mandated turnaround times are met as well as required processes and workflows are adhered to.
Responsibilities
Investigate and resolve complaints and grievances in accordance with State and/or Plan guidelines. Ensure all components of the grievance/complaint are researched and addressed.
Prepare State Fair Hearing packets and coordinate scheduling State Fair Hearing reviews.
Assemble necessary information for the plan so they may appropriately investigate member appeals/complaints when we are not delegated.
Monitor shared mailboxes and department e‑mails to ensure cases are properly entered into department tracking system and that requests are acknowledged and resolved timely and accurately. Manage workflow to meet department, Plan, State, and company goals and deadlines.
Comply with and resolve proof of compliance and directives.
Contact involved provider office to obtain information to properly review the case. Document provider's/staff's perception of the member's concerns/issues.
Document all complaints/grievances/appeals in department tracking system.
Handle the following types of complaints/grievances: Member Complaints/Grievances, Member Complaints/Grievances submitted by plan (when DQ is secondary), Provider Complaint, SDOH (State Department of Health) complaints, DOI (Department of Insurance) complaints, BBB (Better Business Bureau) complaints, Executive complaints (complaints addressed to executives of DentaQuest), and any other complaints/grievance submitted as part of the formal grievance process.
Qualifications
High School Diploma or GED required.
1 year of C&G experience with demonstrated success in C&G Specialist I or 2 years' experience in claims, customer service, provider network or another operational function.
Proficient with general computer software including Microsoft Excel, Word and Outlook.
Excellent verbal, written, interpersonal, organizational and communication skills.
Excellent research skills with ability to identify underlying issue(s) not articulated.
Ability to remain calm and focused in a high pressure/high workload environment.
Ability to work in a high stress environment.
Ability to prioritize and organize multiple tasks with tight deadlines.
Ability to remain organized with multiple interruptions.
Ability to work overtime as needed or required to meet business objectives.
Salary and Incentives At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business.
Benefits and Inclusive Employment We encourage applications from qualified individuals from all backgrounds and are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email thebrightside@sunlife.com to request an accommodation.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Posting Information Job Category: Customer Service / Operations
Employment Type: Full-time
Seniority Level: Not Applicable
Posting End Date: 22/01/2026
#J-18808-Ljbffr