Director of Appeals and Grievances

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