Director of Appeals and Grievances

A company is looking for a Director, Appeals & Grievances. Key Responsibilities Lead and direct the Appeals & Grievances unit to review and resolve member complaints Provide oversight and training to ensure compliance with Medicare standards in provider dispute processing Analyze grievance and appeals data to identify trends and recommend process improvements 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, including HCFA 1500 and UB92 2 years of supervisory/management experience in a managed care setting Preferred Bachelor's Degree

Apr 3, 2025 - 08:13

A company is looking for a Director, Appeals & Grievances. Key Responsibilities Lead and direct the Appeals & Grievances unit to review and resolve member complaints Provide oversight and training to ensure compliance with Medicare standards in provider dispute processing Analyze grievance and appeals data to identify trends and recommend process improvements 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, including HCFA 1500 and UB92 2 years of supervisory/management experience in a managed care setting Preferred Bachelor's Degree