Senior Remote Appeals and Grievances Leader

Harbor Health; Texas; Hybrid; USD 120,000 - 150,000; Full time

Benefits offered by this job

Fully remote work

Competitive salary & benefits

Generous PTO

10 paid holidays

Medical, Dental, and Vision Insurance

401(k) Investment Plan

Professional development

Collaborative and dynamic work culture

Job summary

Harbor Health is seeking an experienced Appeals & Grievances Manager to lead and optimize our complaint, grievance, and appeals operations in a fully remote, nationwide capacity. You will manage a remote team, drive process improvements, and ensure compliance with federal and state requirements while enhancing member satisfaction and operational efficiency.

The role requires deep regulatory knowledge, a track record of high-performing resolution teams, and hands-on experience with core grievance

Qualifications

• Minimum of 5–7 years in managed care or health plan operations.
• Minimum of 2–3 years in a team lead, supervisory, or managerial capacity managing remote staff.
• Deep knowledge of federal and state appeal regulations, external review mandates, and grievance classification taxonomies.

Responsibilities

• Oversee intake, investigation, processing, and resolution of member and provider complaints, grievances, and appeals.
• Ensure adherence to statutory turnaround times and regulator requirements.
• Lead readiness for DOl market conduct examinations, internal audits, and accreditation surveys.

Skills

Remote leadership

Regulatory knowledge

Team leadership

Process improvement

Data analysis

Education

Bachelor’s degree in Healthcare Administration

Tools

Axiscore modules

Job description

Harbor Health is seeking an experienced Appeals & Grievances Manager to lead and optimize our complaint, grievance, and appeals operations in a fully remote, nationwide capacity. You will manage a remote team, drive process improvements, and ensure compliance with federal and state requirements while enhancing member satisfaction and operational efficiency.

The role requires deep regulatory knowledge, a track record of high-performing resolution teams, and hands-on experience with core grievance