Ohio Licensed Appeals Director

A company is looking for a Director of Appeals & Grievances. Key Responsibilities Lead and direct the Appeals & Grievances unit, ensuring compliance with regulatory standards Oversee the triage of member complaints and appeals, ensuring adherence to state and federal regulations Analyze grievance and appeals data to identify trends and implement 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 management role Experience with various types of medical claims processing 2 years of supervisory/management experience in a managed care setting

Apr 5, 2025 - 05:49

A company is looking for a Director of Appeals & Grievances. Key Responsibilities Lead and direct the Appeals & Grievances unit, ensuring compliance with regulatory standards Oversee the triage of member complaints and appeals, ensuring adherence to state and federal regulations Analyze grievance and appeals data to identify trends and implement 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 management role Experience with various types of medical claims processing 2 years of supervisory/management experience in a managed care setting