Director of Appeals and Grievances
Company: VirtualVocations
Location: Vista
Posted on: May 14, 2025
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Job Description:
A company is looking for a Director, Appeals & Grievances.
Key Responsibilities
Lead and direct the Grievance and Appeals Unit to review and
resolve member complaints
Provide oversight and training for provider dispute and appeals
units to ensure compliance with Medicare standards
Analyze grievance and appeals data to identify trends and recommend
process improvements
Required Qualifications
Associate's Degree or 4 years of Medicare grievance and appeals
experience
7 years of experience in healthcare claims review and member
appeals processing, including 2 years in a managerial role
Experience with various medical claims types, including HCFA 1500
and UB92
2 years of supervisory/management experience in a managed care
setting
Keywords: VirtualVocations, Hawthorne , Director of Appeals and Grievances, Executive , Vista, California
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