Director – Grievance & Appeals

Centene Corporation

. Oversee member appeals and grievance processes .

Posted 11/3/2026full-timeRemote • Florida • United StatesLead💰 $107,700 - $199,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in overseeing member appeals and grievance processes while ensuring regulatory compliance and operational efficiency. Proven ability to manage cross-functional teams and address risk management issues effectively.

Highest-signal resume keywords

Grievances ManagementHealthcare Law ExperienceOperational ManagementCross-Functional Team LeadershipRegulatory Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Risk AssessmentProcess DesignPolicy ImplementationBudget DevelopmentVariance ReportingCase PreparationLegal CoordinationPerformance ManagementTraining DevelopmentForecasting

Soft Skills

Problem SolvingCommunicationLeadershipCollaborationGuidance

Industry Keywords

Managed Care OperationsAppeals ProcessGrievance ProcessFinancial Risk ManagementLegal InvolvementHealth Plan ComplianceAdministrative LawOperational EfficiencyPerformance ImprovementMember Services

About the role

Key responsibilities & impact

Oversee member appeals and grievance processes
Direct and ensure efficient operational management of appeals and grievance departments/functions
Participate on internal committees and provide input on risk assessment activities and regulatory changes
Design and implement processes, policies, trainings and procedures for regulatory compliance
Address below-standard performance and resolve risk management issues
Track and trend preventable issues and grievances and lead procedural improvement committees
Minimize legal and financial risk for providers, employers and members
Determine potential loss and financial risk of unusual occurrence cases
Identify need for in-house legal involvement and coordinate with plan attorneys on litigated cases
Help oversee case preparation and research
Appear in court for small claims and administrative law judge cases
Develop operational budgets and complete forecasts and variance reporting
Lead development of Business Area Requirement Reports and business cases
Provide guidance, policy interpretation and compliance support across the Health Plan
Perform other duties as required

Requirements

What you’ll need

Must reside within the state of Florida
Bachelor's Degree in a related field or equivalent experience
5+ years of experience in grievances, appeals, or healthcare law related fields
Previous management experience in managed care operations
Experience managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff
Master's Degree preferred

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation