Grievances & Appeals Operations Lead

Delta Dental of California; Camp Hill (Cumberland County); Hybrid; USD 72,000 - 151,000; Full time

Benefits offered by this job

Competitive base and incentive pay

401(k) with robust matching

Rich medical & pharmacy benefits

100% employer-paid dental and vision

Holistic wellbeing program

Paid time off + holidays

Career development & tuition

Adoption and family support

Volunteer opportunities

Employee discount program

Job summary

Delta Dental of California is seeking a Manager Grievance & Appeals to lead the department, oversee staff, and ensure compliant processing of claims across multiple state standards. The role emphasizes staff development, process optimization, and strong collaboration with business owners to reduce grievance volumes while delivering high-quality care.

Requirements include 5+ years in healthcare operations and 1+ year in supervision, plus excellent communication and organizational skills.

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 abilities.
• Strong interpersonal, written, and verbal communication skills.
• Exceptional inventory management skills.
• Proficiency with Microsoft Office programs (Word, Excel, Outlook).
• 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

Management experience

Critical thinking

Time management

Communication skills

Inventory management

MS Office

Confidentiality

Job description

Delta Dental of California is seeking a Manager Grievance & Appeals to lead the department, oversee staff, and ensure compliant processing of claims across multiple state standards. The role emphasizes staff development, process optimization, and strong collaboration with business owners to reduce grievance volumes while delivering high-quality care.

Requirements include 5+ years in healthcare operations and 1+ year in supervision, plus excellent communication and organizational skills.