Director, Grievance & Appeals
Core
Oversees member appeals and grievance processes, ensuring efficient operational management, compliance, and risk mitigation for a health plan.
Role type
Senior management operations director (grievance & appeals)
Builds
Appeals and grievance operational processes, policies, and risk management frameworks
Domain
Healthcare / Managed Care
Required skills
Strategic planning, process design, risk management, budget forecasting, legal coordination, court representation, team leadership, regulatory compliance
Preferred skills
Master's degree, healthcare law expertise, managed care operations experience
Technologies
Business Area Requirement Reports (BARR), budgeting tools, case management systems
Responsibilities
Direct operational management of appeals and grievance departments, design and implement compliance processes, manage legal and financial risk, appear in court for small claims and administrative cases, provide fiscal management and budgeting, lead procedural improvement committees
Seniority
Director, strategic leadership & operations
