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Director of Appeals and Grievances

Company: VirtualVocations
Location: Jamaica
Posted on: November 2, 2024

Job Description:

A company is looking for a Director of Appeals and Grievances.



Key Responsibilities

Manage a large Appeals and Grievance team and ensure compliant processing of cases
Conduct training, identify improvement opportunities, and ensure audit activities are performed
Oversee the timely processing of Appeals and Grievances while meeting Service Level Agreements


Required Qualifications, Training, and Education

Bachelor's degree in business administration, healthcare, or related field; Master's degree preferred
At least 10 years of experience in a supervisory or management role, preferably in healthcare or insurance
Minimum of 5 years of experience in a grievance and appeals environment with knowledge of CMS regulations
Experience in medical benefits and healthcare industry regulations
Certification or progress toward certification in a relevant field is highly preferred

Keywords: VirtualVocations, Philadelphia , Director of Appeals and Grievances, Executive , Jamaica, Pennsylvania

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