New

Senior Quality Program Advisor - Grievance & Appeals

Delta Dental of California
$63,700 - $133,500
dental insurance, paid time off, paid holidays, tuition reimbursement, 401(k), employee discount
United States, Pennsylvania, Camp Hill
Jun 05, 2025
JOB DESCRIPTION The Senior Quality Program Advisor will develop and manage reports to track KPIs, conduct root cause analysis, and provide strategic solutions aligned with the Quality Program business goals and strategy roadmap. This role will serve as the primary SME for business processes, advising leadership on best practices and industry trends. Additionally, the Senior Quality Program Advisor will manage projects, deliver strategic plans, and communicate complex findings to stakeholders, ensuring continuous alignment with operational objectives and enhancing function efficiency. This role will primarily function in the Grievance & Appeals (G&A) department and serves as a subject matter expert (SME) for G&A operations, acting as a key liaison between departments to ensure regulatory compliance and optimize performance. The G&A Senior Quality Program Advisor supports leadership by analyzing inventory data, identifying trends, and providing actionable insights to improve turnaround times. Additionally, the advisor plays a critical role in developing reports and presentations that drive strategic decision-making and enhance operational efficiency. RESPONSIBILITIES Develop and manage operational reports to track key performance indicators (KPIs), ensuring accurate insights into business data. Conduct data-driven root cause analysis to identify strategic solutions that align with business goals. Serve as the primary SME for operational processes, advising leadership on best practices, trends, and potential risks. Stay current on emerging developments and trends within the industry to recommend proactive adjustments to processes. Provide recommendations to management on operational adjustments to enhance efficiency and outcomes. Participate in the planning, coordination, and execution of operational initiatives related to assigned business portfolio and the Quality program holistically. Manage timelines, deliverables, and communication to ensure the successful completion of projects. Provide high-level guidance and strategic recommendations, ensuring that business needs are met and aligned with organizational goals. Deliver strategic plans, high-level requirement documents, and executive presentations that outline the proposed solutions and their alignment with business capabilities. Communicate complex findings in a clear, concise manner to non-technical stakeholders. Monitor the effectiveness of implemented changes, ensuring continuous alignment with operational objectives and stakeholder expectations. Serve as a G&A SME and a liaison to other departments within the enterprise; specifically with a focus on a deep understanding of regulatory requirements, G&A operational practices and Key Performance Indicators. Partner with G&A leadership to support departmental initiatives; creating detailed reports and presentations with actionable recommendations. Conduct analyses within G&A's inventory to assist leadership with ensuring turnaround times are met and mitigating avoidable misses. Continuously monitor G&A data to determine what is driving inventory; partner with G&A leadership to suggest ways to drive down inventory. This list is not all-inclusive and you are expected to perform other duties as requested or assigned. QUALIFICATIONS 4+ w/Bachelor's degree Experience in collecting and compiling data, identifying basic trends, and preparing initial drafts of reports. Experience in gathering and reporting on customer feedback. Understanding of quality assurance processes and standards. Proficiency in analyzing data to identify trends, root causes, and strategic solutions. Awareness of emerging developments and trends within the industry. Knowledge of and ability to execute project planning, coordination, and execution best practices. Ability to conduct data-driven root cause analysis and develop insights. Expertise in developing and managing operational reports to track KPIs. Strong ability to communicate complex findings clearly to non-technical stakeholders. Excellent verbal, written and interpersonal communication skills. Capability to serve as a subject matter expert and advise leadership on best practices and potential risks. Ability to identify and recommend operational adjustments to enhance efficiency and outcomes. Ability to monitor the effectiveness of implemented changes and ensure alignment with operational objectives. 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 19. $63,700 - $133,500 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. #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