Director, Complaints Grievance & Appeals
Core
Directing Complaints, Grievances & Appeals (CG&A) operations, training, and reporting functions for a healthcare benefits provider.
Role type
Senior leadership operations director
Builds
Data-driven operating models, process improvements, and corrective action plans
Domain
Healthcare benefits administration and compliance
Deliverable
dashboards & analysis
Required skills
Healthcare operations management, leadership, CMS/NCQA/state regulations compliance, root cause analysis, budgeting, performance management, strategic planning
Preferred skills
Clinical and industry terminology knowledge
Technologies
Excel, MS Word, Outlook
Responsibilities
Establish strategic direction for CG&A function, monitor daily/monthly turnaround times, complete and interpret monthly reporting, develop department policies and procedures, oversee training material development, participate in client audits, build annual budgets, manage staff performance
Seniority
Director, strategic leadership
