Director of Appeals and Grievances

Job Summary

A company is looking for a Director of Appeals & Grievances (Remote).

Key Responsibilities

• Lead and direct the Appeals & Grievances unit to 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 implement 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/grievance processing, including 2 years in a managerial role
• Experience reviewing various types of medical claims
• 2 years of supervisory/management experience in a managed care setting
• Bachelor's Degree preferred