Director of Appeals and Grievances

Job Summary

A company is looking for a Director of Appeals & Grievances.

Key Responsibilities

• Lead and direct the Appeals & Grievances unit to review and resolve member complaints in compliance with Medicare standards
• Oversee and train local plans' provider dispute and appeals units to ensure adherence to Medicare requirements
• Analyze grievance and appeals data to identify trends and recommend process improvements for member satisfaction

Required Qualifications

• Associate's degree or 4 years of Medicare grievance and appeals experience
• 7 years of experience in healthcare claims review and member appeals processing, including 2 years in a managerial role
• Experience with various types of medical claims processing
• 2 years of supervisory/management experience in appeals/grievance processing within a managed care setting
• Bachelor's degree is preferred