Director of Appeals and Grievances

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

Jun 21, 2025 - 05:40

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