Grievances & Appeals Operations Leader

SCAN Group; Long Beach (CA); On-site; USD 80,000 - 116,000; Full time

Benefits offered by this job

Annual bonus program

Wellness Program

Generous PTO

11 paid holidays + 1 floating + 1 bday

401(k) with employer match

Employee recognition program

Tuition reimbursement

Opportunity to make a difference

Job summary

SCAN is seeking a Manager of Grievances and Appeals Operations in California to lead the day-to-day Grievance and Appeals team, ensuring timely, compliant processing of Medicare-related inquiries and robust performance management. The role emphasizes regulatory adherence, staff development, and cross-functional collaboration.

The position offers an annual salary range and opportunities to influence policy, workflow enhancements, and AI-driven improvements that support member care and

Qualifications

• Bachelor's Degree or equivalent in Healthcare or human service related field.
• 5+ years in managed health care setting, Medicare/Medicaid preferred.
• Excellent presentation, group motivation and supervisory skills.
• Strong strategic planning, critical thinking and leadership skills.
• Demonstrated management experience.
• Experience coordinating diverse groups to achieve program goals.
• Ability to prioritize multiple tasks, work independently and in a team environment.
• Ability to work well in a fast-paced and dynamic environment.
• Strong interpersonal, written and verbal communication skills.
• Strong organizational skills.
• Ability to multitask and maintain confidentiality.
• Working knowledge of Medicare, Medi-Cal, DMHC, DHCS, and NCQA guidelines.
• Demonstrated ability to work with all levels of staff.
• Microsoft Office Suite advanced.

Responsibilities

• Lead day-to-day operations of the Grievance and Appeals team to meet goals.
• Maintain workflows, tools, and monitoring to ensure timely actions.
• Support staff performance and solve issues, including staffing considerations.
• Ensure compliance with CMS, DMHC, DHCS, and NCQA guidelines via processes.
• Train staff to review Medicare Part C and D inquiries and prepare cases for review.
• Foster teamwork through staff and interdisciplinary meetings.
• Keep department policies and training materials up to date.
• Collaborate to develop department metric reporting for productivity.
• Represent the department on committees and liaise with the Medical Director.
• Recruit, hire, orient, and develop staff; maintain safe work environment.
• Support SCAN's AI initiatives and overall vision.
• Other duties as assigned.

Skills

Presentation skills

Leadership

Strategic planning

Analytical skills

Communication skills

Team management

Confidentiality

Education

Bachelor's Degree in Healthcare or related field

Tools

Microsoft Office Suite

Job description

SCAN is seeking a Manager of Grievances and Appeals Operations in California to lead the day-to-day Grievance and Appeals team, ensuring timely, compliant processing of Medicare-related inquiries and robust performance management. The role emphasizes regulatory adherence, staff development, and cross-functional collaboration.

The position offers an annual salary range and opportunities to influence policy, workflow enhancements, and AI-driven improvements that support member care and