Grievance & Appeals Manager

Liberty Dental Plan Careers•, OK

2d•$85,000 - $95,000•Remote

About The Position

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 also contributes significantly to Quality Improvement initiatives, regulatory compliance activities, committee support, and audit preparedness.

Requirements

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.

Nice To Haves

Bachelor's degree preferred.

Responsibilities

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 implement federal and state regulatory changes impacting grievance and appeals operations.
Identify process improvements and collaborate across departments to develop corrective actions and prevent recurrence of issues.
Evaluate workflows and delegated activities for existing health plan partnerships and support implementation of processes for new partnerships.
Develop reports, analyses, and executive-level insights for leadership teams and internal committees.
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.

Benefits

Competitive pay structure and savings options to help you reach your financial goals.
Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.
Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.
100% employer-paid dental coverage for employees and eligible dependents.
Vision insurance with low-cost premiums for employee-only coverage and dependents.
Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.
Flexible Spending Accounts for healthcare and dependent care expenses.
Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.
Long-term disability coverage.
Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts.
Employee Assistance Program (EAP) to support mental health and well-being.
Generous vacation and sick leave policies, with the ability to roll over unused time.
10 paid company holidays.
Tuition reimbursement for eligible educational expenses.
Remote or hybrid work options available for various positions.