Grievances & Appeals Operations Leader

SCAN Group; United States; On-site; USD 80,000 - 116,000; Full time

Benefits offered by this job

Annual bonus program

Wellness program

Generous PTO

11 holidays + floating + birthday

401(k) with employer match

Tuition reimbursement

Employee recognition program

Job summary

SCAN is a nonprofit health organization delivering Medicare Advantage and related services across multiple states. The Manager, Grievances and Appeals Operations will lead the Grievance and Appeals program to ensure efficient, compliant handling of member rights and regulatory requirements.

The role emphasizes staff development, workflow optimization, and collaboration with the Medical Director to achieve organizational goals, with a strong focus on process improvement and staff training.

Qualifications

• Bachelor's degree in healthcare or human services or equivalent.
• 5+ years in a managed health care setting; Medicare/Medicaid preferred.
• Excellent presentation, group motivation and supervisory skills.
• Strong strategic planning, critical thinking and leadership.
• Demonstrated management experience and cross-team coordination.
• Ability to prioritize multiple tasks and work independently in a fast-paced environment.
• Strong interpersonal, written and verbal communication skills.
• Advanced MS Office skills with confidentiality awareness.
• Knowledge of Medicare/Medicaid, DMHC, DHCS, NCQA guidelines.

Responsibilities

• Oversee day-to-day operations of the Grievance and Appeals team to meet goals.
• Ensure timely completion of grievance and appeal activities with effective workflows.
• Provide first-line staff support and problem-solving to improve systems and tools.
• Ensure compliance with CMS, DMHC, DHCS, and NCQA guidelines; monitor standards.
• Train staff to review Medicare Part C and D inquiries and classify cases.
• Facilitate staff and interdisciplinary meetings; promote teamwork.
• Maintain current department policies, workflows, and training materials.
• Collaborate with stakeholders to develop and review productivity metrics.
• Represent the department on committees and coordinate with the Medical Director.
• Recruit, orient, and develop staff; maintain a safe work environment.
• Support SCAN’s AI initiatives and organizational goals.
• Perform other duties as assigned.

Skills

Leadership

Strategic planning

Regulatory knowledge

Communication skills

Problem solving

Staff management

MS Office proficiency

Team collaboration

Time management

Education

Bachelor's degree in Healthcare or human services

Tools

Microsoft Office Suite

Job description

SCAN is a nonprofit health organization delivering Medicare Advantage and related services across multiple states. The Manager, Grievances and Appeals Operations will lead the Grievance and Appeals program to ensure efficient, compliant handling of member rights and regulatory requirements.

The role emphasizes staff development, workflow optimization, and collaboration with the Medical Director to achieve organizational goals, with a strong focus on process improvement and staff training.