Manager, Grievance & Appeals

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Ensure the proper handling of member grievance appeals, provider appeals, or requests for a State Fair Hearing.

• Act as the primary liaison with the State.

• Oversee the daily operations of Grievance & Appeals Coordinators.

• Guarantee that grievances and appeals are managed within the established timelines and contractual legal obligations.

• Track appeals and grievances and supply senior management with monthly trend analysis reports.

• Ensure that member and provider grievances are addressed and investigated in accordance with contract stipulations.

• Collaborate with state, local, and federal authorities, local communities, and the public regarding grievance and appeals issues.

• Incorporate changes in federal and state laws into the organization's regulatory framework.

• Suggest solutions, ensure issues are rectified, and inform departments of corrective actions to avert future occurrences.

• Provide training and guidance to agencies in developing compliant procedures.

• Review and handle incoming incident and accident reports.

⛳️ Requirements

• A bachelor's degree in a related discipline or equivalent experience.

• A minimum of 3 years of experience in healthcare/law, grievances, and appeals.

• Prior experience in a leadership role within a functional area, managing cross-functional teams on significant projects, or supervisory experience.

• Supervisory experience may encompass hiring, training, delegating tasks, and overseeing staff performance.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plans.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off, in addition to holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.