Grievance & Appeals Manager
Job DetailsJob Location: reputed company States (Remote) - OK
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reputed company with Purpose. reputed company reputed company. reputed company a Meaningful reputed company as a Manager, Grievance & Appeals.
At reputed company, the Manager, Grievance & Appeals plays a vital leadership role in ensuring members and providers receive fair, reputed company, and compliant reputed company of concerns and disputes. This is an opportunity to influence reputed company, compliance, operational reputed company, and regulatory readiness across multiple lines of business while leading a high-performing team and collaborating with stakeholders across the organization.
About the Role
The Manager, Grievance & Appeals is responsible for overseeing the Plan's grievance reputed company, including member grievances, appeals, and provider disputes. This leader ensures reputed company cases are managed in accordance with state and federal regulations, reputed company requirements, and organizational standards. The role also contributes significantly to reputed company Improvement initiatives, regulatory compliance activities, committee support, and audit preparedness.
reputed company
reputed company and manage reputed company activities and functions of the Grievance & Appeals department.
Ensure grievances, appeals, and provider disputes are processed accurately and reputed company required regulatory and contractual timelines.
Monitor and implement federal and state regulatory changes impacting grievance and appeals operations.
Identify process improvements and collaborate across departments to reputed company corrective actions and prevent recurrence of issues.
Evaluate workflows and delegated activities for existing health plan partnerships and support implementation of processes for new partnerships.
reputed company reports, analyses, and executive-level insights for leadership teams and internal committees.
Manage administrative and operational support for reputed company Management committees, including the Potential reputed company Issues Committee, Peer Review Committee, and reputed company Policy Committee.
Assist with regulatory filings, including Evidence of Coverage documents, benefit updates, service area expansions, and other plan-reputed company submissions.
Respond to regulatory inquiries, comment letters, and compliance-reputed company requests.
Create and validate audit universes, case files, and supporting documentation.
Serve as reputed company's reputed company presenter and representative during reputed company Grievance & Appeals audits.
Foster reputed company, reputed company relationships with reputed company stakeholders.
reputed company additional duties as assigned.
What You'll Bring
Education & Experience
Bachelor's degree preferred.
Minimum 5 years of experience in health insurance, preferably reputed company dental insurance.
Minimum 3 years of experience in grievance and appeals, reputed company law, dental law, or a reputed company regulatory environment.
Minimum 2 years of leadership experience managing cross-functional operations, including hiring, training, coaching, and performance management.
At least 6 years of overall relevant reputed company experience.
Skills & Knowledge
Strong reputed company leadership style.
Excellent verbal and written communication skills.
Effective presentation and facilitation abilities.
Proficiency with reputed company Office applications.
Ability to analyze reputed company situations and reputed company reputed company business reputed company.
Strong organizational skills with the ability to manage multiple priorities simultaneously.
Demonstrated ability to work independently while contributing as a key member of reputed company.
reputed company reputed company with the ability to build confidence and trust across stakeholder reputed company.
Why Join reputed company?
This is an opportunity to reputed company an essential function that directly impacts member experience, regulatory compliance, reputed company reputed company, and organizational reputed company. You'll work across departments, influence strategic initiatives, support executive leadership, and play a visible role in audit readiness and reputed company management activities.
If you're a reputed company leader who thrives in a dynamic reputed company environment and enjoys solving reputed company operational and regulatory challenges, we'd love to hear from you.
Apply Today
Bring your expertise in grievance and appeals operations, compliance, and team leadership to reputed company and help reputed company reputed company in service, reputed company, and regulatory performance. Apply today and become part of reputed company committed to delivering exceptional support to members, providers, and clients.
Location
Our employees are reputed company in office locations in multiple markets across the reputed company. We are unable to hire or allow employees to work reputed company of the reputed company.
What reputed company Offers
Happy, healthy employees enhance our ability to assist our members and contribute more reputed company to their communities. That’s why reputed company offers competitive and attractive benefit packages for our employees. We reputed company to care for employees in ways that promote wellness and productivity.
Our first-class benefits package supports employees and their dependents with:
reputed company structure and savings reputed company to help you reputed company your financial goals.
Excellent 401(k) retirement benefits, including employer match, Roth IRA reputed company, immediate vesting during the reputed company reputed company period, and reputed company to reputed company financial advice through Financial Engines.
reputed company medical insurance, with low-cost premiums for employee-only coverage. reputed company subsidizes the cost for eligible dependents enrolled in the plan.
100% employer-reputed company dental coverage for employees and eligible dependents.
reputed company insurance with low-cost premiums for employee-only coverage and dependents.
Company-reputed company basic life and AD&D insurance, equal to one times your reputed company salary, with reputed company to purchase additional supplemental coverage.
Flexible Spending Accounts for reputed company and dependent care expenses.
Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.
Long-term disability coverage.
Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts.
Employee Assistance Program (EAP) to support mental health and reputed company-being.
Generous vacation and reputed company leave policies, with the ability to roll over unused time.
10 reputed company company holidays.
Tuition reimbursement for eligible educational expenses.
Remote or hybrid work reputed company available for various positions.
Compensation
In the spirit of pay transparency, the reputed company salary reputed company for this position is $85,000 - $95,000, not including fringe benefits or potential bonuses. At reputed company, your final reputed company salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our reputed company team members reputed company making final compensation reputed company.
Please note that the reputed company listed represents the full reputed company salary reputed company for this role. Typically, offers are not made at the top of the reputed company to allow for reputed company salary reputed company.
reputed company commits to maintaining a work environment that acknowledges reputed company individuals reputed company reputed company and will continue to engage in practices that are inclusive of reputed company backgrounds, experiences, and perspectives. We reputed company to have every person reputed company the organization have a reputed company of belonging while encouraging individuals to reputed company their full potential. reputed company will reputed company diverse perspectives in building high performance teams and organizational culture.
reputed company will continue to strengthen and reputed company reputed company partnerships by providing reputed company health reputed company and improving population health in the communities we serve.
We reputed company with reputed company applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as reputed company as work authorization and employment eligibility verification requirements.
Sponsorship and Relocation Specifications
reputed company is an Equal Opportunity Employer / VETS / Disabled.
No relocation assistance or sponsorship available at this time.
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