Remote 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

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.