Manager, Grievance & Appeals

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Liberty Dental Plan

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2002

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Liberty Dental Plan is a U. S. -based dental insurance provider offering Medicaid (including Medi-Cal), Medicare Advantage, commercial, individual & family, and group dental plans across multiple states. The company operates member-facing services (find-a-dentist, member portal, mobile app, claims and eligibility tools) and provider-facing services (provider portal, network enrollment, claims submission, clinical guidelines, and value-based programs). Liberty Dental Plan focuses on dental benefits administration, provider network management, compliance and credentialing, and serving members, providers, and brokers.

📋 Description

• Lead and oversee all functions of the Grievance & Appeals department. • Ensure appeals, grievances, and provider disputes are processed accurately and within required regulatory and contractual timeframes. • Maintain compliance with applicable state and federal regulations and client-specific requirements. • Monitor regulatory changes and integrate new requirements into organizational grievance and appeals processes. • Identify operational issues, recommend solutions, and implement corrective actions to prevent recurrence. • Evaluate existing workflows and develop procedures to support new and expanding health plan partnerships. • Develop reports, analyses, and operational insights for internal committees, leadership teams, and key stakeholders. • Provide administrative and operational support for Quality Management activities and committees. • Assist with regulatory filings, including Evidence of Coverage (EOC) documents, benefit filings, service area expansions, and other plan-related submissions. • Respond to regulatory inquiries, requests, and comment letters. • Create audit materials, including universes and case file documentation, ensuring accuracy and completeness. • Serve as the primary presenter and representative for Liberty Dental Plan during internal and external Grievance & Appeals audits. • Foster positive, professional relationships with internal and external stakeholders. • Perform additional duties as assigned.

🎯 Requirements

• Minimum of 6 years of relevant professional experience. • Previous experience serving as a lead within an operational environment. • Experience managing cross-functional teams and initiatives. • Experience hiring, training, coaching, and managing employee performance. • Strong verbal and written communication skills. • Excellent presentation and stakeholder engagement skills. • Demonstrated ability to exercise sound judgment and make independent decisions. • Strong organizational skills with the ability to manage multiple priorities simultaneously. • Proficiency in Microsoft Office applications. • Ability to collaborate effectively across departments and build trusted working relationships.

🏖️ 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, 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.