Manager, Grievance & Appeals
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Job Description
Lead Grievance & Appeals operations at Liberty Dental Plan ensuring compliance and quality management. Oversee member grievances and appeals while guiding a high-performing team.
Responsibilities:
- Lead and oversee all functions of the Grievance & Appeals department.
- Ensure appeals, grievances, and provider disputes are processed accurately and within required regulatory and contractual timeframes.
- Maintain compliance with applicable state and federal regulations and client-specific requirements.
- Monitor regulatory changes and integrate new requirements into organizational grievance and appeals processes.
- Identify operational issues, recommend solutions, and implement corrective actions to prevent recurrence.
- Evaluate existing workflows and develop procedures to support new and expanding health plan partnerships.
- Develop reports, analyses, and operational insights for internal committees, leadership teams, and key stakeholders.
- Provide administrative and operational support for Quality Management activities and committees.
- Assist with regulatory filings, including Evidence of Coverage (EOC) documents, benefit filings, service area expansions, and other plan-related submissions.
- Respond to regulatory inquiries, requests, and comment letters.
- Create audit materials, including universes and case file documentation, ensuring accuracy and completeness.
- Serve as the primary presenter and representative for Liberty Dental Plan during internal and external Grievance & Appeals audits.
- Foster positive, professional relationships with internal and external stakeholders.
- Perform additional duties as assigned.
Requirements:
- Minimum of 6 years of relevant professional experience.
- Previous experience serving as a lead within an operational environment.
- Experience managing cross-functional teams and initiatives.
- Experience hiring, training, coaching, and managing employee performance.
- Strong verbal and written communication skills.
- Excellent presentation and stakeholder engagement skills.
- Demonstrated ability to exercise sound judgment and make independent decisions.
- Strong organizational skills with the ability to manage multiple priorities simultaneously.
- Proficiency in Microsoft Office applications.
- Ability to collaborate effectively across departments and build trusted working relationships.
Benefits:
- Competitive pay structure and savings options to help you reach your financial goals.
- Excellent 401(k) retirement benefits , including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.
- Affordable medical insurance , with low-cost premiums for employee-only coverage.
- Liberty subsidizes the cost for eligible dependents enrolled in the plan.
- 100% employer-paid dental coverage for employees and eligible dependents.
- Vision insurance with low-cost premiums for employee-only coverage and dependents.
- Company-paid basic life and AD&D insurance , equal to one times your base salary, with options to purchase additional supplemental coverage.
- Flexible Spending Accounts for healthcare 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, and gym discounts.
- Employee Assistance Program (EAP) to support mental health and well-being.
- Generous vacation and sick leave policies, with the ability to roll over unused time.
- 10 paid company holidays.
- Tuition reimbursement for eligible educational expenses.
- Remote or hybrid work options available for various positions.
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