Grievance & Appeals Operations Leader

Delta Dental Ins.; Oakland (CA); On-site; USD 72,000 - 151,000; Full time

Benefits offered by this job

Competitive base pay

401(k) matching

Medical, dental, vision benefits

Paid holidays and birthday off

Tuition reimbursement

Career development

Job summary

Delta Dental Ins. in the United States is seeking a Manager of Grievance & Appeals responsible for leading the Grievances & Appeals Department and ensuring compliance with state standards and organizational goals.

You will oversee a team to review and process claims, drive efficiency, and align with enterprise-wide objectives. The role requires coordinating staff development, monitoring performance, and delivering training to enhance grievance handling while maintaining strict confidentiality.

Qualifications

• 5+ years of healthcare operations experience.
• 1+ years of supervisor or management experience.
• Strong critical thinking and analytical skills.
• Excellent organizational and time management skills, with the ability to multi-task while maintaining attention to detail.
• Strong interpersonal, written, and verbal communication skills.
• Exceptional inventory management skills.
• Ability to maintain strict confidentiality.

Responsibilities

• Manages, develops and trains staff to achieve department objectives including determining staffing needs, setting goals, interviewing, selecting, coaching, and evaluating the performance of all direct reports.
• Manages and, through a team, resolves claim appeal, dispute, and reconsideration case inventory with determination to exceed established regulatory requirements and performance guarantees.
• Analyzes trends and makes recommendations for processing procedures to ensure efficiency and cost containment.
• Collaborates with departmental business owners on process improvement to decrease grievance and appeal volume.
• Develops and implements best practice protocols within the division and the Enterprise.
• In conjunction with G&A Supervisors and internal partners, delivers process, procedure, and systemic training opportunities and efficiencies to support grievance and appeal team members.
• Evaluates and implements organizational standards to meet corporate and divisional goals and objectives.

Skills

Healthcare operations

Staff supervision

Critical thinking

Organizational skills

Time management

Communication skills

Inventory management

Confidentiality

Tools

Microsoft Office

Job description

Delta Dental Ins. in the United States is seeking a Manager of Grievance & Appeals responsible for leading the Grievances & Appeals Department and ensuring compliance with state standards and organizational goals.

You will oversee a team to review and process claims, drive efficiency, and align with enterprise-wide objectives. The role requires coordinating staff development, monitoring performance, and delivering training to enhance grievance handling while maintaining strict confidentiality.