Grievance & Appeals Manager

Liberty Dental Plan; United States; Remote; USD 85,000 - 95,000; Full time

Benefits offered by this job

Competitive pay structure

Excellent 401(k) retirement benefits

Affordable medical insurance

100% employer-paid dental coverage

Vision insurance

Life & AD&D Insurance

Flexible Spending Accounts

Long-term disability coverage

Wellness programs & EAP

Job summary

Liberty Dental Plan seeks a Manager, Grievance & Appeals to lead the department across member grievances, appeals, and provider disputes. You will ensure timely, compliant resolutions and drive regulatory readiness while partnering with stakeholders to improve quality outcomes.

In this leadership role, you will oversee processes, implement corrective actions, prepare performance reports, and represent the plan during audits.

Qualifications

• Bachelor's degree preferred.
• Minimum 5 years of experience in health insurance, preferably within dental insurance.
• Minimum 3 years in grievance and appeals, healthcare law, dental law, or a related regulatory environment.
• Minimum 2 years of leadership experience managing cross-functional operations.
• At least 6 years of overall relevant professional experience.

Responsibilities

• Lead and manage all activities and functions of the Grievance & Appeals department.
• Ensure grievances, appeals, and provider disputes are processed accurately and within required regulatory and contractual timelines.
• Monitor and interpret federal, state, client and regulatory changes impacting grievance and appeals operations.
• Lead root cause analysis activities, develop corrective action strategies, and partner with business leaders to address issues and drive improvements.
• Evaluate workflows and delegated activities for existing health plan partnerships and support implementation of processes for new partnerships.
• Develop and present performance reports, trend analyses, and regulatory insights to leadership teams, clients, auditors and regulatory agencies.
• Manage administrative and operational support for Quality Management committees, including the Potential Quality Issues Committee, Peer Review Committee, and Public Policy Committee.
• Assist with regulatory filings, including Evidence of Coverage documents, benefit updates, service area expansions, and other plan-related submissions.
• Respond to regulatory inquiries, comment letters, and compliance-related requests.
• Create and validate audit universes, case files, and supporting documentation.
• Serve as Liberty Dental Plan's primary presenter and representative during internal and external Grievance & Appeals audits.
• Foster positive, professional relationships with internal and external stakeholders.

Skills

Collaborative leadership

Verbal communication

Written communication

Presentation & facilitation

MS Office

Analytical thinking

Multi-tasking

Independent work

Education

Bachelor's degree

Job description

Job DetailsJob Location: All States (Remote) - OKLead with Purpose. Drive Quality. Make a Meaningful Impact as a Manager, Grievance & Appeals.

At Liberty Dental Plan, the Manager, Grievance & Appeals plays a vital leadership role in ensuring members and providers receive fair, timely, and compliant resolution of concerns and disputes. This is an opportunity to influence quality, compliance, operational excellence, and regulatory readiness across multiple lines of business while leading a high-performing team and collaborating with stakeholders across the organization.

About the Role

The Manager, Grievance & Appeals is responsible for overseeing the Plan's grievance system, including member grievances, appeals, and provider disputes. This leader ensures all cases are managed in accordance with state and federal regulations, client requirements, and organizational standards. The role serves as a subject matter expert responsible for supporting regulatory compliance, quality outcomes, policy governance audit readiness and continuous improvement initiatives.

What You'll Do

• Lead and manage all activities and functions of the Grievance & Appeals department.
• Ensure grievances, appeals, and provider disputes are processed accurately and within required regulatory and contractual timelines.
• Monitor and interpret federal, state, client and regulatory changes impacting grievance and appeals operations.
• Lead root cause analysis activities, develop corrective action strategiesstrategies, and partner with business leaders to address issues and drive improvements.
• Evaluate workflows and delegated activities for existing health plan partnerships and support implementation of processes for new partnerships.
• Develop and present performance reports, trend analyses, and regulatory insights to leadership teams, clients, auditors and regulatory agencies.
• Manage administrative and operational support for Quality Management committees, including the Potential Quality Issues Committee, Peer Review Committee, and Public Policy Committee.
• Assist with regulatory filings, including Evidence of Coverage documents, benefit updates, service area expansions, and other plan-related submissions.
• Respond to regulatory inquiries, comment letters, and compliance-related requests.
• Create and validate audit universes, case files, and supporting documentation.
• Serve as Liberty Dental Plan's primary presenter and representative during internal and external Grievance & Appeals audits.
• Foster positive, professional relationships with internal and external stakeholders.
• Perform additional duties as assigned.

What You'll Bring

Education & Experience

• Bachelor's degree preferred.
• Minimum 5 years of experience in health insurance, preferably within dental insurance.
• Minimum 3 years of experience in grievance and appeals, healthcare law, dental law, or a related regulatory environment.
• Minimum 2 years of leadership experience managing cross-functional operations, including hiring, training, coaching, and performance management.
• At least 6 years of overall relevant professional experience.

Skills & Knowledge

• Strong collaborative leadership style.
• Excellent verbal and written communication skills.
• Effective presentation and facilitation abilities.
• Proficiency with Microsoft Office applications.
• Ability to analyze complex situations and make sound business decisions.
• Strong organizational skills with the ability to manage multiple priorities simultaneously.
• Demonstrated ability to work independently while contributing as a key member of a team.
• Professional presence with the ability to build confidence and trust across stakeholder groups.

Why Join Liberty Dental Plan?

This is an opportunity to lead an essential function that directly impacts member experience, regulatory compliance, quality outcomes, and organizational success. You'll work across departments, influence strategic initiatives, support executive leadership, and play a visible role in audit readiness and quality management activities.

If you're a collaborative leader who thrives in a dynamic healthcare environment and enjoys solving complex operational and regulatory challenges, we'd love to hear from you.

Location

Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.

What Liberty Offers

Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That’s why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity.

Our first-class benefits package supports employees and their dependents with:

• Competitive pay structure and savings optionsto help you reach your financial goals.
• Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.
• Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.
• 100% employer-paid dental coveragefor employees and eligible dependents.
• Vision insurancewith low-cost premiums for employee-only coverage and dependents.
• Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.
• Flexible Spending Accountsfor healthcare and dependent care expenses.
• Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.
• Long-term disability coverage.
• Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts.
• Employee Assistance Program (EAP)to support mental health and well-being.
• Generous vacation and sick leavepolicies, with the ability to roll over unused time.
• 10 paid company holidays.
• Tuition reimbursementfor eligible educational expenses.
• Remote or hybrid work optionsavailable for various positions.

Compensation

In the spirit of pay transparency, the base salary range for this position is $85,000 - $95,000, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions.

Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth.

We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.

Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture. Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve.

Sponsorship and Relocation Specifications

Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled.

No relocation assistance or sponsorship available at this time.