Grievance and Appeals Coordinator

Grievances and Appeals Coordinator

Capitol Dental Care

Help members feel heard. Help improve access to care.

Behind every grievance or appeal is a person seeking answers about their dental care. At Capitol Dental Care, you’ll help ensure those concerns receive thoughtful attention, thorough review, and a clear response.

Capitol Dental Care is committed to improving the oral health of Oregon Health Plan members through access to high-quality, coordinated dental care. We work with our staff and panel dental offices and Coordinated Care Organization (CCO) partners to support the members and communities we serve.

We’re looking for a Grievances and Appeals Coordinator who brings compassion, sound judgment, and strong organizational skills to managing member concerns from intake through resolution.

Your Impact

In this role, you’ll serve as a key connection between members, dental offices, clinical reviewers, and our CCO partners. You’ll investigate concerns, coordinate reviews, and help members understand the outcome and next steps. Your attention to detail and follow-through will help ensure each case receives a complete, timely, and well-documented response.

What You’ll Do

• Listen and respond to member concerns. Receive grievances and appeals, identify each issue raised, document requests accurately, and recognize urgent concerns that require immediate escalation.
• Investigate and organize case information. Gather dental records, treatment notes, radiographs, authorizations, claims, and correspondence to build complete review files.
• Coordinate clinical reviews. Work with the Grievances and Appeals Manager, Dental Director, and dental reviewers to obtain findings and determinations within required timeframes.
• Keep members and partners informed. Provide timely updates and maintain professional, responsive communication with members, representatives, providers, dental offices, internal teams, and CCOs.
• Prepare clear, member-friendly correspondence. Draft acknowledgment, resolution, and appeal determination letters that address each concern and explain findings, decisions, and next steps using approved templates and review processes.
• Help coordinate resolutions. Support recommended remedies, second opinions, referrals, and follow-up with dental offices and internal teams.
• Manage deadlines and documentation. Track standard and expedited cases, follow applicable requirements and CCO processes, and maintain complete records through case closure.

What You’ll Bring

• A compassionate, professional approach to helping people navigate concerns about their care.
• Strong written and verbal communication skills, including the ability to explain complex information in clear, accessible language.
• Excellent organization, attention to detail, and the ability to manage multiple cases and deadlines.
• An investigative mindset, with the persistence to gather missing information, identify discrepancies, and follow issues through to resolution.
• Sound judgment when handling sensitive information, recognizing urgent concerns, and escalating barriers.
• The ability to collaborate effectively with clinical teams, dental offices, internal departments, and external partners.

Experience in healthcare or dental administration, member services, grievances and appeals, or a related field would be valuable in this role.

Make a Difference with Capitol Dental Care

Bring your communication skills, compassion, and commitment to follow-through to work that matters. Join Capitol Dental Care and help Oregon Health Plan members receive the attention, answers, and support they deserve.

Apply today to join our team.