About the Role
At Liberty Dental Plan, we are committed to delivering exceptional service, regulatory excellence, and quality care experiences for our members and provider partners. We are seeking an experienced Manager, Grievance & Appeals to lead our Grievance and Appeals (G&A) operations and ensure compliance with state, federal, client, and regulatory requirements.
In this leadership role, you will oversee member grievances, member appeals, and provider disputes while guiding a high-performing team. You will play a key role in quality management, regulatory compliance, audit readiness, and continuous process improvement across multiple lines of business. This is an excellent opportunity for a collaborative leader who thrives in a fast-paced healthcare environment and enjoys driving operational excellence.
What You'll Do
- 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.
What You'll Bring
Required Qualifications
- 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.
Preferred Qualifications
- Bachelor's degree (BA/BS).
- Minimum of 5 years of experience within the health insurance industry; dental insurance experience preferred.
- Minimum of 3 years of experience in grievance and appeals operations, healthcare law, dental law, or related regulatory functions.
- Experience working within regulated healthcare environments and quality management programs.
Success Factors
The ideal candidate will demonstrate:
- A collaborative and engaging leadership style.
- Strong analytical and problem-solving abilities.
- Confidence presenting to leadership, auditors, and external stakeholders.
- The ability to remain composed and effective in complex or high-pressure situations.
- A commitment to compliance, quality improvement, and operational excellence.
- A team-oriented mindset with a focus on service and accountability.
Why Join Us
At Liberty Dental Plan, you'll have the opportunity to make a meaningful impact on member experience, quality outcomes, and regulatory excellence. You'll work alongside dedicated professionals who are passionate about delivering exceptional service while supporting continuous improvement across the organization.
If you're a motivated healthcare operations leader with expertise in grievance and appeals management, we encourage you to apply and become part of our mission-driven team.
