Grievance & Appeals Manager

Job Details

Job Location:

All States (Remote) - OKLead with Purpose. Drive Quality. Make a Meaningful Impact as a Manager, Grievance & Appeals.

At Liberty Dental Plan, the Manager, Grievance & Appeals plays a vital leadership role in ensuring members and providers receive fair, timely, and compliant resolution of concerns and disputes. This is an opportunity to influence quality, compliance, operational excellence, and regulatory readiness across multiple lines of business while leading a high-performing team and collaborating with stakeholders across the organization.

The Manager, Grievance & Appeals is responsible for overseeing the Plan's grievance system, including member grievances, appeals, and provider disputes. This leader ensures all cases are managed in accordance with state and federal regulations, client requirements, and organizational standards. The role serves as a subject matter expert responsible for supporting regulatory compliance, quality outcomes, policy governance audit readiness and continuous improvement initiatives.

• 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 strategiesstrategies, 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.
• Perform additional duties as assigned.

• Bachelor's degree preferred.
• Minimum 5 years of experience in health insurance, preferably within dental insurance.
• Minimum 3 years of experience in grievance and appeals, healthcare law, dental law, or a related regulatory environment.
• Minimum 2 years of leadership experience managing cross-functional operations, including hiring, training, coaching, and performance management.
• At least 6 years of overall relevant professional experience.

• Strong collaborative leadership style.
• Excellent verbal and written communication skills.
• Effective presentation and facilitation abilities.
• Proficiency with Microsoft Office applications.
• Ability to analyze complex situations and make sound business decisions.
• Strong organizational skills with the ability to manage multiple priorities simultaneously.
• Demonstrated ability to work independently while contributing as a key member of a team.
• Professional presence with the ability to build confidence and trust across stakeholder groups.

This is an opportunity to lead an essential function that directly impacts member experience, regulatory compliance, quality outcomes, and organizational success. You'll work across departments, influence strategic initiatives, support executive leadership, and play a visible role in audit readiness and quality management activities.

If you're a collaborative leader who thrives in a dynamic healthcare environment and enjoys solving complex operational and regulatory challenges, we'd love to hear from you.