Director of Appeals and Grievances

Job Summary

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

Key Responsibilities

• Manage a large Appeals and Grievance team and oversee compliant processing of cases
• Monitor inventory and assign work to analysts while ensuring adherence to processes and systems
• Develop and update Desk Level Procedures, provide continuous training, and mentor A&G Analysts

Required Qualifications

• Bachelor's degree in business administration, Economics, Health Care, Information Systems, Statistics, or related field; Master's preferred
• 10 years of experience in a supervisory or management role; healthcare or insurance experience is a plus
• 5 years of experience in a grievance and appeals environment, including knowledge of CMS regulations
• Experience in medical benefits and healthcare industry regulations, including claims and authorizations
• Legal research experience and familiarity with federal and state regulatory laws preferred