Senior Appeals & Grievances Manager

Detego Health; Omaha (NE); Hybrid; USD 80,000 - 100,000; Full time

Benefits offered by this job

401(k) matching

Health insurance

Dental insurance

Vision insurance

Life insurance

Paid time off

Health savings account

Employee assistance program

Job summary

Detego Health in Omaha seeks an Appeals and Grievances Manager to lead the appeals & grievances function within Compliance. You will oversee intake, tracking, and resolution of appeals, ensure regulatory timelines, and manage a team dedicated to accuracy and audit readiness.

The role emphasizes collaboration with Claims, Legal, Customer Service, and other internal teams to improve processes, with hybrid in-office/work arrangement and a focus on quality and compliance in health plan operations.

Qualifications

• Associate degree or equivalent required.
• 3+ years of experience in appeals, grievances, claims administration, compliance, or healthcare operations.
• Experience leading employees, workflows, or operational functions.
• Strong knowledge of documentation requirements, regulatory timelines, and case management practices.

Responsibilities

• Lead, coach, and develop employees responsible for appeals and grievances.
• Oversee intake, assignment, review, tracking, and resolution of member and provider appeals and grievances.
• Ensure cases are processed within applicable state, federal, contractual, and organizational timelines.
• Review complex, high-risk, or time-sensitive cases and coordinate escalation and resolution.
• Prepare leadership reports and support regulatory or client audits.

Skills

Team leadership

Performance metrics

Regulatory knowledge

Communication

Problem solving

Education

Associate degree or equivalent

Job description

Detego Health in Omaha seeks an Appeals and Grievances Manager to lead the appeals & grievances function within Compliance. You will oversee intake, tracking, and resolution of appeals, ensure regulatory timelines, and manage a team dedicated to accuracy and audit readiness.

The role emphasizes collaboration with Claims, Legal, Customer Service, and other internal teams to improve processes, with hybrid in-office/work arrangement and a focus on quality and compliance in health plan operations.