Director, Complaints Grievance & Appeals

About the role

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop‑loss insurance, and healthcare navigation. DentaQuest manages dental and vision benefits for more than 33 million Americans, delivering outcomes‑based, cost‑effective solutions for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. The Director, Complaints, Grievances & Appeals (CG&A) is responsible for directing CG&A operations as well as the training and reporting functions for CG&A. This role is required to participate in client audits, presentations, implementations, corrective action plans, develop and implement process improvements, as well as meet client requirements regarding contractual turnaround times. The Director is responsible for guiding and motivating team members and completing performance and wage evaluations of staff. This individual will also be required to establish a data‑driven operating model that will determine the ongoing costs of the CG&A function and the associated strategy and tactics to develop a more efficient and effective operating model.

Responsibilities

• Establish the strategic