Director, Appeals and Grievance

Location: Remote – US-based candidates only, no visa sponsorship available

About the Role

This role will provide business-aligned guidance focused on governance, compliance, and operational risk management. You will partner with leaders, compliance stakeholders, and cross-functional teams to translate complex issues into practical recommendations. The position offers the opportunity to strengthen responsible execution, improve decision-making, and support sustainable growth within a healthcare environment.

Responsibilities

• Develop and direct Appeals and Grievance department services
• Oversee the policy development to meet compliance standards
• Manage staff to address complaints, appeals, and grievances
• Collaborate with Medical Directors to improve appeal trends
• Ensure adherence to contractual and accreditation requirements
• Lead external audits for compliance to NCQA, CMS, and other regulations
• Support compliance inquiries and create corrective action plans

Qualifications

• Bachelor's Degree required
• Minimum five years of healthcare complaints/appeals experience
• Strong strategic planning skills
• Proficiency in regulatory compliance and audits
• Experience in developing policies and workflows

Pay

$110,000 – $130,000 annually

Potential for annual discretionary bonuses based on eligibility

Benefits

• Medical, Dental, and Vision plans
• Adoption, Fertility, and Surrogacy reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental and Family Caregiver Leave
• Emergency Backup Care
• Comprehensive disability and critical illness plans
• Life Insurance coverage
• 401k/403B with employer match
• Tuition Assistance up to $5,250/year and discount opportunities
• Student Debt Pay Down benefit up to $10,000
• Pet Insurance and Legal Resources Plan