Manager, Grievance & Appeals - Remote

Overview

The Manager, Grievance & Appeals plays a crucial role in managing member complaints and ensuring compliance in a highly regulated healthcare environment, while leading a team dedicated to processing grievances and appeals.

In Short

• Manage member grievance and appeals processes.
• Ensure compliance with state and federal regulations.
• Lead and oversee Grievance & Appeals Coordinators.
• Provide monthly reporting on trends to senior management.
• Integrate legal changes into the regulatory system.
• Collaborate with external stakeholders on grievance issues.
• Train staff on grievance and appeals procedures.
• Review and process incident reports.
• Advise on corrective measures to prevent recurrences.
• Work in a metrics-driven environment.

Requirements

• Bachelor’s degree in a related field or equivalent experience.
• 3+ years of experience in healthcare/law, grievances, and appeals.
• Experience in managing cross-functional teams.
• Supervisory experience including hiring and training.
• Strong people leadership skills.
• Operational experience in a healthcare setting.
• Ability to work in a highly regulated environment.
• Excellent communication and reporting skills.
• Ability to work with various external constituencies.
• Knowledge of federal and state healthcare laws.

Benefits

• Competitive pay and health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible work schedules including remote options.
• Comprehensive benefits package.
• Commitment to diversity and equal opportunity.
• Support for candidate journey and accommodations.
• Access to high-quality healthcare solutions.
• Encouragement of personal and professional growth.