Appeals/Grievances Manager - Healthcare (100K)

The Complaints, Appeals, and Grievance (CAG) Manager will provide guidance to the team regarding day-to-day activities, compliance, and business subject matter expertise to maintain and enhance our CAG software product. This includes managing the product throughout the product lifecycle, gathering and prioritizing product and customer requirements, and defining the product vision. The CAG Manager will also be responsible to oversee resources and engage customers on the products potential with an innovative perspective on product development.

Essential Duties and Responsibilities

• Perform product demos and drive successful product Implementations
• Able to adapt to competing demands, take on new responsibilities, and adjust plans to meet changing priorities
• Scope and prioritize activities based on business and customer impact
• Occasional travel – once per quarter typically – to client sites or conferences as necessary.
• Translate product strategy into detailed requirements and roadmap
• Work closely with developing internal teams to deliver quality and optimize resources
• Maintain current subject matter expertise in relevant regulatory requirements
• Gain a deep understanding of customer experience, identify and fill product gaps and generate new ideas that grow market share, improve customer experience and drive growth
• Evaluate product enhancement plans to ensure that they are consistent with product line strategy and that the message is effectively conveyed
• Create buy-in for the product vision both internally and with key external partners
• Manage within the organization, supervising up to five (5) Product members on day to day operations

Requirements

• Auditing and Corrective Action Plan/Risk Mitigation Experience required
• 5 years of managed care experience specifically in Complaints, Appeals and Grievances
• Demonstrated proficiency in computer skills to include Word, Power Point and Excel
• Direct Customer facing experience and Presentation experience
• Previous supervisory experience required.

• Bachelors preferred; some health care or product development experience can be used in lieu of the education requirement.

Additional Skills Requirements

• Position can sit remote. Must be willing to work EST.
• Excellent interpersonal and communication skills (written and oral)
• Experience identifying key metrics and cross-walking requirements
• Team player/team builder/coach experienced
• Dedication to a high degree of customer service