Manager of Grievances and Appeals

Job Summary

Managing daily operations within the Grievance and Appeals program, the full-time Manager of Grievances and Appeals will ensure efficient and compliant handling of appeals and grievances for members while leading the team remotely.

Key responsibilities

• Oversee the Grievance and Appeals team to achieve organizational goals and manage productivity
• Establish and maintain effective workflows and processes to ensure timely completion of grievance and appeal functions
• Ensure compliance with regulatory standards and provide training to staff on case review procedures

Required qualifications

• Bachelor's Degree or equivalent experience in Healthcare or a related field
• 5+ years of experience in a managed health care setting, preferably with Medicare/Medicaid
• Demonstrated management experience and strong leadership skills
• Working knowledge of guidelines and regulations relevant to Grievance and Appeals
• Advanced proficiency in Microsoft Office Suite