Director, Complaints Grievance – Appeals

Sun Life

. Direct CG&A operations, training, and reporting functions .

Posted 10/12/2026full-timeUnited StatesLead💰 $114,600 - $171,900 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates extensive experience in managing CG&A operations within the healthcare sector, focusing on compliance with CMS and NCQA guidelines, process improvements, and team leadership. Proven ability to develop data-driven strategies that enhance operational efficiency and meet client contractual requirements.

Highest-signal resume keywords

7+ Years Healthcare Management ExperienceLeadership ExperienceCMS and NCQA Compliance KnowledgeExcellent Communication SkillsData-Driven Process Improvement

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Process ImprovementData AnalysisRoot-Cause AnalysisPerformance EvaluationContract Compliance MonitoringBudget DevelopmentWorkflow Efficiency ReportingTraining Material DevelopmentClient Audit ParticipationPolicy Development

Soft Skills

Team MotivationInterpersonal SkillsAttention to DetailPresentation SkillsAnalytical Skills

Tools & Technologies

ExcelMS WordOutlook

Industry Keywords

Healthcare RegulationsState Medicaid ComplianceCommercial RegulationsClinical TerminologyOperational Efficiency

About the role

Key responsibilities & impact

Direct CG&A operations, training, and reporting functions
Participate in client audits, presentations, implementations, and corrective action plans
Develop and implement process improvements
Meet client contractual turnaround-time requirements
Guide and motivate team members
Complete performance and wage evaluations of staff
Establish a data-driven operating model to determine CG&A costs and develop an efficient operating model
Establish strategic direction for the CG&A function
Improve employee engagement, customer satisfaction, and operational efficiency
Monitor daily and monthly turnaround times for contract compliance
Complete, communicate, and interpret monthly reporting requirements
Develop action plans for gaps or potential deficiencies
Ensure compliance with client expectations, contracts, state laws and regulations, CMS, and NCQA guidelines
Develop and update department policies, procedures, and processes
Develop root-cause resolutions for operational and personnel issues
Oversee training-material development and departmental training
Identify, implement, quantify, and report workflow efficiencies
Participate in on-site and off-site client audits
Maintain a strategic process for Corrective Action Plans and perform root-cause analysis
Participate in business implementation projects and act as CG&A Subject Matter Expert
Build a data-based annual budget and establish efficiency-enhancing processes
Manage CG&A staff performance
Adhere to business processes and perform other duties as needed

Requirements

What you’ll need

7+ years’ experience managing in healthcare or related experience
7+ years of previous leadership experience
Bachelor degree in related field or related experience required
Ability to travel
Knowledge of CMS and NCQA and State Medicaid/Commercial regulations or compliance requirements, including differences by product type
Excellent verbal and written communication skills with attention to detail
Excellent analytical skills
Previous experience presenting to high-level management and/or external constituents
Excellent presentation and interpersonal skills
Extensive knowledge of general computer software, including Excel, MS Word, and Outlook
Knowledge of clinical and industry terminology and procedures preferred
Ability to work in a fast-paced environment with multiple interruptions
Ability to communicate in an active office environment
Ability to efficiently operate job-related office equipment
Ability to communicate via telephone
Ability to sit for 80% or more of an 8-hour workday
Ability to read and view a computer screen

Benefits

Comp & perks

Discretionary annual incentive award based on individual performance and overall business performance
Generous vacation and sick time
Paid family, parental and adoption leave
Medical coverage
Company-paid life and AD&D insurance
Disability programs
Partially paid sabbatical program
401(k) employer match
Stock purchase options
Employer-funded retirement account
Flexible, inclusive and collaborative work environment
Career growth support
Reasonable accommodations for qualified individuals with disabilities or special disabled veterans