Manager, Grievance & Appeals

Job DetailsJob Location: All States (Remote) - OKPosition Type: Full Time a { text-decoration: none; color: #464feb; } tr th, tr td { border: 1px solid #e6e6e6; } tr th { background-color: #f5f5f5; } 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. Location & BenefitsLocation Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.    What Liberty Offers Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That’s why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity.   Our first-class benefits package supports employees and their dependents with: 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.   Compensation In the spirit of pay transparency, the base salary range for this position is $90,000 - $97,000 annually, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions.   Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth.   Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture.    Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve.    We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.   Sponsorship and Relocation Specifications Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled. No relocation assistance or sponsorship available at this time.