New

Director Grievances & Appeals

Delta Dental of California
$122,400 - $265,100
dental insurance
United States, California, Rancho Cordova
Apr 09, 2026
JOB DESCRIPTION The Director of Grievance and Appeals assumes leadership for the program development and strategic planning of the Delta Dental Grievance and Appeals Department. This role guides and develops the G&A leadership team ensuring that all operations, including the processing of appeals, grievances, and regulatory complaints, meet compliance standards and adherence to multiple state and federal -mandated standards, guidelines and reporting requirements. The Director works closely with various stakeholders to identify trends in complaints and makes recommendations that will improve the patient and provider experience. RESPONSIBILITIES Directs and oversees department strategy, operations and compliance with regulatory-required (e.g., CMS, DHCS, DMHC and NCQA) grievance and appeals processes, protocols, and activities. Ensures that department processes and procedures support overall Quality Improvement program requirements and meet accreditation, audit and Company standards. Leads collaborative efforts with enterprise departments to continuously pursue opportunities for improvement that stem from grievance data and appeals trends. Leads cross-functionally to ensure that initiatives are executed successfully, results and outcomes are measured, and insights are shared back to all stakeholders. Defines and implements organizational structure to facilitate business performance. Ensures optimization of resources by resolving any duplicative improvement efforts and organization structures. Serves as the Chair of the Grievance Insight Committee, providing direction and recommendations based on Grievance and appeals trends. Creates an environment that promotes employee engagement and job satisfaction within the department. Develops and manages annual department and project budgets; identifies variances and takes corrective actions as appropriate. Develops and implements departmental policies, procedures, and work flows incorporating new processes into existing systems and work flows while ensuring compliance with federal, state, and accrediting agencies. Represents Grievance and Appeal Department for all audits including pre-exam audit preparation, mock exams, actual audits, preparation of corrective action plans, and follow-up with regulators. QUALIFICATIONS 12+ years w/Bachelor's degree; 3+ years management Additional experience may be accepted in lieu of education or degree A minimum of 6 years of related G&A experience. A minimum of 5 years of leadership experience of 150+ person organization, preferably with some union environment experience. Core skills in project and program management, portfolio strategy/management, and organizational change management. Proven ability to lead teams, develop people and influence others. Excellent interpersonal skills and the ability to work effectively and build partnerships at all levels of the organization, including C-Suite. Skill in translating complex trends, processes, outcomes and data into easily understandable and actionable concepts. Ability to develop strategies and strategic solutions, and drive through to execution. Proven ability to work effectively in a matrixed environment. Strong critical thinking, problem-solving and analytical skills. Strong organizational/time management skills with the ability to multi-task. Knowledge of health care operations and provider network development; knowledge of Delta Dental enterprise operations preferred. Knowledge of Current Dental Terminology ("CDT") codes and dental nomenclature. Knowledge of enterprise's processing policies and guidelines for dental procedures, limitations and exclusions. Demonstrated excellence in communication and negotiation, especially in complex settings and in a cross-cultural environment. Knowledge of quality improvement methodologies such as Lean Six Sigma. Ability to travel to various operations sites required. Licenses * Six Sigma Green Belt Certification. Pref' * Lean Six Sigma Black Belt. Pref' * Certified Project Management Professional (PMP)-PMI. Pref' 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 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 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 If You Are A Current Employee Click Here* To Apply