Director, Complaints, Grievances & Appeals Operations

Sun Life Assurance Company of Canada; Kansas City (MO); Híbrido; USD 115.000 - 172.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Paid time off

401(k) match

Stock purchase plan

Parental leave

Disability insurance

Descripción de la vacante

Sun Life U.S. is seeking a Director, Complaints, Grievances & Appeals (CG&A) to lead CG&A operations and training, with a focus on audits, process improvements, and cost management. The role requires ensuring compliance with CMS/NCQA and contract requirements while motivating staff and delivering data-driven results.

The position works in a hybrid model, traveling as needed, and reports to the CG&A leadership. A strong background in healthcare compliance and leadership is essential.

Formación

• 7+ years’ experience of managing in healthcare or related experience required.
• 7+ years of previous leadership required.
• Bachelor degree in related field or related experience required.
• Ability to travel.
• Requires knowledge of CMS and NCQA and State Medicaid/Commercial regulations or compliance requirements.
• Excellent verbal and written communication skills.
• Excellent analytical skills.
• Previous experience presenting to high-level management or external constituents.
• Excellent presentation and interpersonal skills.
• Extensive knowledge of general computer software (Excel, MS Word, Outlook).

Responsabilidades

• Establish the strategic direction of the CG&A function including tactics to improve employee engagement, customer satisfaction and operational efficiency.
• Monitor daily and monthly turnaround time to ensure compliance with client contract requirements.
• Complete, communicate, and interpret monthly reporting requirements and develop action plans if gaps are found.
• Ensure department meets client expectations and contract requirements, CMS and NCQA guidelines.
• Develop and update department policies and processes for compliance.
• Develop and implement root cause resolutions to internal and external issues.
• Oversee and direct development of training materials and staff training.
• Identify and report on efficiencies in department workflow.
• Participate in and complete client audits on site and off site as needed.
• Develop and maintain CAP processes and perform root cause analysis.
• Participate in business implementations as SME for CGA.
• Build a data-driven annual budget and establish efficiency-improving processes.
• Performance management of CGA staff.
• Adhere to business processes.
• Other duties as needed.

Conocimientos

Leadership

Healthcare knowledge

Communication

Analytical skills

Presentation skills

MS Office

Educación

Bachelor's degree

Herramientas

Excel

MS Word

Outlook

Descripción del empleo

Sun Life U.S. is seeking a Director, Complaints, Grievances & Appeals (CG&A) to lead CG&A operations and training, with a focus on audits, process improvements, and cost management. The role requires ensuring compliance with CMS/NCQA and contract requirements while motivating staff and delivering data-driven results.

The position works in a hybrid model, traveling as needed, and reports to the CG&A leadership. A strong background in healthcare compliance and leadership is essential.