Director, Complaints & Appeals — Data-Driven Ops Leader

Sun Life Financial; Milwaukee (WI); Hybrid; USD 115,000 - 172,000; Full time

Benefits offered by this job

Vacation & Sick Time

Family Leave

Medical Coverage

Life Insurance

Disability Benefits

Sabbatical Program

401(k) Match

Stock Purchase Plan

Retirement Account

Job summary

Sun Life U.S. is seeking a Director of Complaints, Grievances & Appeals to lead CG&A operations in a hybrid Milwaukee environment. The role focuses on enhancing engagement, customer satisfaction, and operational efficiency while meeting CMS/NCQA requirements.

You will guide policy development, training, audits, and performance management across a data-driven organization. The position requires 7+ years in healthcare leadership, CMS/NCQA knowledge, strong communication, and the ability to travel

Qualifications

• 7+ years’ experience of managing in healthcare or related experience required.
• 7+ years of leadership experience required.
• Bachelor degree in related field or related experience required.
• Ability to travel.
• Knowledge of CMS and NCQA regulations or compliance requirements.

Responsibilities

• Set strategic direction for CG&A with focus on engagement, satisfaction, and efficiency.
• Monitor daily/monthly turnaround times to ensure contract compliance.
• Produce and interpret monthly CG&A reports; implement action plans as needed.
• Develop and maintain department policies, procedures, and processes for compliance.
• Lead root-cause analysis and corrective action plans; manage CAP process.
• Oversee staff performance management and training materials.

Skills

Healthcare leadership

Data analysis

Verbal communication

Written communication

Strategy development

Education

Bachelor's degree in related field

Tools

Excel

MS Word

Outlook

Job description

Sun Life U.S. is seeking a Director of Complaints, Grievances & Appeals to lead CG&A operations in a hybrid Milwaukee environment. The role focuses on enhancing engagement, customer satisfaction, and operational efficiency while meeting CMS/NCQA requirements.

You will guide policy development, training, audits, and performance management across a data-driven organization. The position requires 7+ years in healthcare leadership, CMS/NCQA knowledge, strong communication, and the ability to travel