Grievance and Appeals Director

Job Description

The Grievance and Appeals Director provides strategic leadership and operational oversight for Delta Dental's Grievance and Appeals (G&A) function. This role is responsible for the development, execution, and continuous evolution of the department's strategy, ensuring all grievance, appeal, and regulatory complaint activities are compliant, efficient, and aligned with enterprise objectives.

Leading a large, high-performing organization, the Director will guide and develop the G&A leadership team while ensuring adherence to complex state and federal regulatory requirements. This role partners closely with cross-functional stakeholders to analyze complaint and appeal trends, identify root causes, and drive enterprise-wide improvements that enhance both patient and provider experiences.

Responsibilities

• Provide strategic direction and oversight of all G&A operations, ensuring compliance with regulatory requirements (e.g., CMS, DHCS, DMHC, NCQA) and internal standards
• Ensure departmental processes align with Quality Improvement program requirements, accreditation standards, and audit expectations
• Lead cross-functional collaboration to identify trends, root causes, and opportunities for continuous improvement based on grievance and appeals data
• Drive execution of enterprise initiatives by aligning stakeholders, measuring outcomes, and communicating insights and recommendations
• Design and optimize organizational structure to support performance, scalability, and efficient resource utilization
• Serve as Chair of the Grievance Insight Committee, delivering data-driven recommendations and strategic guidance
• Foster a high-performing, engaged culture that promotes accountability, transparency, and employee satisfaction
• Oversee department budgeting and financial performance, identifying variances and implementing corrective actions
• Develop and implement policies, procedures, and workflows that ensure compliance while improving operational efficiency
• Lead all audit-related activities, including preparation, execution, corrective action planning, and regulatory follow-up

Qualifications

• 8+ years of experience in healthcare operations (G&A experience not required)
• 3+ years of leadership experience overseeing large-scale teams (150+ employees)
• Proven ability to lead, develop, and influence leaders and teams in a complex, matrixed environment
• Strong executive presence with the ability to build partnerships and influence at all levels, including C-suite
• Demonstrated ability to translate complex data, trends, and processes into clear, actionable insights
• Experience developing strategy and driving execution with measurable outcomes
• Strong critical thinking, problem-solving, and analytical capabilities
• Excellent organizational and time management skills, with the ability to manage multiple priorities
• Knowledge of healthcare operations and provider network environments
• Knoweldge of quality improvement methodologies (e.g., Lean Six Sigma)
• Exceptional communication and negotiation skills across diverse and cross-functional teams
• Ability to travel up to 25% as needed

Base Pay Information

The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications, and the ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity.


Pay Grade 24. $122,400 - $265,100

About Us

Behind the smile! We are dedicated to safeguarding the health and financial stability of our employees and their loved ones. This commitment extends beyond the workplace to foster personal growth and holistic wellbeing. Our life-changing rewards package includes:

• Competitive base and incentive pay
• 401(k) with robust matching and non-matching contributions
• Rich medical & pharmacy benefits
• 100% employer-paid dental and vision benefits
• Holistic wellbeing program with deep financial incentives
• Generous paid time off plus 12 paid holidays and your birthday off
• Culture of growth and learning: career development; tuition reimbursement; recognition program
• Family support: adoption assistance, fertility treatment, child, elder & pet care assistance
• Social responsibility and volunteer opportunities
• Employee discount program

Fair Chance Ordinances and Criminal Background Considerations


This position requires that the applicant undergo a background check. Qualified applicants with arrest or conviction records will be considered for employment in accordance with any applicable federal, state or local laws, including, but not limited to, the California Fair Chance Act, the Los Angeles County Fair Chance Ordinance, the City of Los Angeles Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, and/or New York Corrections Law Article 23-A.


Important Work Authorization Information


Please note, Delta Dental will not sponsor applicants for work visas for this position.


#LI-Hybrid

About the Team

At Delta Dental, we're behind millions of smiles and counting. For over 68 years, we've served our communities by increasing access to affordable, quality care - but that commitment to care extends beyond the people we serve, to the dedicated employees who make those smiles genuine. We've come this far by building fair programs that offer opportunities for advancement, create meaningful connections and improve the lives of our employees and their families. Because we know that when we take exceptional care of each other, we can make a positive impact for all.

We champion an inspirational workplace through our commitment to trust, service, excellence and innovation. Joining us means working for a company that offers stability and balance, opportunities for leadership at all levels, and a work environment focused on teamwork and camaraderie.

Discover the smiling faces behind Delta Dental and experience our values and culture in action by connecting with us on social media. Follow Delta Dental Ins. on Facebook and Instagram, #LifeatDDins on Facebook and Instagram, Delta Dental Ins. on Twitter and Delta Dental Ins. on LinkedIn. If you've got an appetite for innovation and want to be a part of a team that's transforming the future of health care, join us!

Since 1955, we have offered comprehensive, high-quality oral health care benefits to millions of enrollees and built the strongest network of dental providers in the country. The Delta Dental of California network includes affiliates Delta Dental Insurance Company; Delta Dental of Pennsylvania; Delta Dental of New York, Inc.; Delta Dental of the District of Columbia; Delta Dental of Delaware, Inc.; and Delta Dental of West Virginia, providing dental benefits to more than 31 million people across 15 states, the District of Columbia, Puerto Rico and the Virgin Islands.

The company and its affiliates are part of Delta Dental Plans Association (DDPA), a not-for-profit national association based in Oak Brook, Illinois. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories. We offer vision coverage through DeltaVision in 15 states and the District of Columbia. Collectively, we deliver benefits to more Americans than any other dental insurance company.

Delta Dental Ins. is an equal opportunity employer and is committed to providing a professional work environment free from discrimination and harassment. Individuals seeking employment at Delta Dental are considered without regard to race, ethnicity, color, age, sex, religion, national origin, ancestry, pregnancy, sexual orientation, gender identity, gender expression, genetic information, actual or perceived physical or mental disability, registered domestic partner status, caregiver status, marital status, veteran or military status, citizenship status, or any other legally protected category. Delta Dental is committed to providing equal employment opportunities to all employees and applicants for employment. Accordingly, we have adopted and maintain an Equal Employment Opportunity Policy, Harassment-Free Work Environment Policy, and Respectful Workplace policies and will not tolerate violations of these policies.

Unfortunately, our Delta Dental Enterprise is unable to hire individuals residing in Alaska, North Dakota, Nebraska, Hawaii, Oklahoma, Vermont, Maine, West Virginia, New Hampshire, Wyoming, Puerto Rico, District of Columbia (Washington D.C.) or other US Territories at this time.

Proof of eligibility to work in the United States must be provided if selected for hire.

*Delta Dental includes: Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, and Delta Dental of New York

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