About the role

  • Ensure appropriate processing of member grievance appeals, provider appeals, or request for a State Fair Hearing
  • Perform duties as the point of contact with the State
  • Manage the day to day responsibilities of the Grievance & Appeals Coordinators
  • Ensure that the Grievance and Appeals department processes all appeals and grievances in accordance with referred time frames and other contractual legal requirements
  • Monitor appeals and grievances and provide senior management with monthly reporting on trends
  • Ensure that all members and provider grievances are processed and investigated according to contract requirements
  • Work with various external constituencies, i.e., state, local and federal governments, local community and the public related to grievance and appeals
  • Integrate federal and state law changes into company’s regulatory system related to grievance and appeals
  • Recommend solutions and works with department and company staff to ensure problems are corrected and departments are advised of corrective measures to prevent recurrences
  • May provide training and direction to agencies in developing procedures to comply with grievance and appeals requirements
  • Review and process incoming incident/accident reports

Requirements

  • Bachelor’s degree in related field or equivalent experience
  • 3+ plus years of experience in healthcare/law, grievances and appeals
  • Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff

Benefits

  • competitive pay
  • health insurance
  • 401K and stock purchase plans
  • tuition reimbursement
  • paid time off plus holidays
  • flexible approach to work with remote, hybrid, field or office work schedules

Job title

Manager, Grievance & Appeals

Job type

Experience level

Mid levelSenior

Salary

$68,700 - $123,700 per year

Degree requirement

Bachelor's Degree

Location requirements

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