Strategic Director, Complaints & Grievances (Hybrid)

Sun Life

Nashville (TN)

Hybrid

USD 115,000 - 172,000

Full time

9 days ago

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Benefits offered by this job

Vacation and sick time

401(k) matching

Stock purchase options

Flexible work environment

Job summary

Sun Life U.S. is seeking a Director, Complaints, Grievances & Appeals to lead CG&A operations, training, and reporting. The role requires guiding staff, participating in client audits, and implementing process improvements to meet contractual turnaround times.

A data-driven operating model will determine ongoing costs and strategy for the function. The position entails budget management, performance evaluations, and ensuring compliance with CMS/NCQA guidelines while fostering an engaged,

Qualifications

Bachelor's degree or related experience required.
7+ years' experience in healthcare or related field.
7+ years of leadership experience.
Ability to travel.
Knowledge of CMS and NCQA regulations and state Medicaid/commercial requirements.

Responsibilities

Establish strategic direction for CG&A to improve engagement, satisfaction and efficiency.
Monitor and ensure turnaround times align with client contracts.
Prepare and interpret monthly reporting and act on gaps.
Ensure compliance with state laws, CMS and NCQA guidelines.
Develop and update department policies and processes.
Lead root-cause analysis and CAP implementations.
Oversee training materials and staff training.
Manage department budget and efficiency initiatives.
Support client audits and cross-functional projects.