Director, Complaints & Appeals Operations

Sun Life; Nashville (TN); Hybride; USD 120 000 - 170 000; Plein temps

Résumé du poste

Sun Life U.S. is seeking a Director, Complaints, Grievances & Appeals (CG&A) to direct CG&A operations, training, and reporting. The role requires guiding staff, participating in client audits, and implementing process improvements within a hybrid work model.

You will establish a data-driven operating model, manage budgets, and ensure compliance with contract terms, state laws, CMS and NCQA guidelines while leading a team to deliver results.

Qualifications

• 7+ years’ experience managing in healthcare or related field.
• 7+ years of previous leadership experience.

Responsabilités

• Set strategic direction for CGA operations and drive improvements.
• Monitor turnaround times and ensure contract compliance.
• Lead audits, client communications and action plans for deficiencies.
• Develop budgets and drive cost efficiency in CGA.
• Oversee training material development and staff performance.

Connaissances

Leadership

Healthcare operations

Strategic planning

Budgeting

Employee engagement

Description du poste

Sun Life U.S. is seeking a Director, Complaints, Grievances & Appeals (CG&A) to direct CG&A operations, training, and reporting. The role requires guiding staff, participating in client audits, and implementing process improvements within a hybrid work model.

You will establish a data-driven operating model, manage budgets, and ensure compliance with contract terms, state laws, CMS and NCQA guidelines while leading a team to deliver results.