<p>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.</p> <p>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.</p> <ul> <li>Provide strategic direction and oversight of all G&A operations, ensuring compliance with regulatory requirements (e.g., CMS, DHCS, DMHC, NCQA) and internal standards </li><li>Ensure departmental processes align with Quality Improvement program requirements, accreditation standards, and audit expectations </li><li>Lead cross-functional collaboration to identify trends, root causes, and opportunities for continuous improvement based on grievance and appeals data </li><li>Drive execution of enterprise initiatives by aligning stakeholders, measuring outcomes, and communicating insights and recommendations </li><li>Design and optimize organizational structure to support performance, scalability, and efficient resource utilization </li><li>Serve as Chair of the Grievance Insight Committee, delivering data-driven recommendations and strategic guidance </li><li>Foster a high-performing, engaged culture that promotes accountability, transparency, and employee satisfaction </li><li>Oversee department budgeting and financial performance, identifying variances and implementing corrective actions </li><li>Develop and implement policies, procedures, and workflows that ensure compliance while improving operational efficiency </li><li>Lead all audit-related activities, including preparation, execution, corrective action planning, and regulatory follow-up </li><li>8+ years of experience in healthcare operations (G&A experience not required) </li><li>3+ years of leadership experience overseeing large-scale teams (150+ employees) </li><li>Proven ability to lead, develop, and influence leaders and teams in a complex, matrixed environment </li><li>Strong executive presence with the ability to build partnerships and influence at all levels, including C-suite </li><li>Demonstrated ability to translate complex data, trends, and processes into clear, actionable insights </li><li>Experience developing strategy and driving execution with measurable outcomes </li><li>Strong critical thinking, problem-solving, and analytical capabilities </li><li>Excellent organizational and time management skills, with the ability to manage multiple priorities </li><li>Knowledge of healthcare operations and provider network environments </li><li>Knoweldge of quality improvement methodologies (e.g., Lean Six Sigma) </li><li>Exceptional communication and negotiation skills across diverse and cross-functional teams </li><li>Ability to travel up to 25% as needed </li></ul> <p>Base Pay Information</p> <p>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.</p> <p>Pay Grade 24. $122,400 - $265,100</p>