Delta Dental of Arizona, the state’s #1 dental and vision insurance company, is seeking an Appeals & Grievance Supervisor with great leadership mentality, strong analytical and problem- solving skills to join our team! 

The Supervisor of Appeals & Grievances is responsible for overseeing the handling of appeals, grievances and Arizona Department of Insurance and Financial Institutions (AZDIFI) and Attorney General consumer complaints. This role ensures standardization, quality assurance (QA), training, and continuous improvement of processes related to appeals, grievances, and regulatory complaints and that all activities comply with statutory requirements and company guidelines and procedure.  

The Supervisor leads efforts to document, map, and improve workflows; develop training programs; and implement quality monitoring practices. This role partners closely with internal departments, regulatory bodies (including AZDIFI and the Attorney General’s Office), and external stakeholders (including Delta Dental of Michigan/Renaissance) to ensure accurate, compliant, and consistent handling of all cases.

About You

You’re a collaborative leader who enjoys guiding a team through complex situations and delivering thoughtful, compliant solutions. You stay organized in a fast-paced environment, balancing priorities while keeping work on track and meeting key deadlines.

You build strong relationships across teams and communicate clearly with both internal partners and external stakeholders. With a proactive mindset, you take ownership, support your team, and continuously look for ways to improve processes and the overall experience.

Sound like you? Keep reading, we’d love to tell you more!

 Essential Duties

• Supervise and support team members handling appeals, grievances, and regulatory complaints and coach staff to improve technical skills, regulatory knowledge, and decision-making quality.
• Design, implement, and maintain comprehensive training programs for new hires and ongoing staff development.
• Create training materials, job aids, and standard operating procedures (SOPs) to ensure consistency in case handling.
• Conduct regular quality reviews and identify trends, root causes, and opportunities for improvement based on QA findings.
• Serve as a subject matter expert on regulatory requirements, timelines, and compliance standards.
• Review and evaluate written appeals, grievances and complaints from individual members, group members, and providers.
• Partner with Sales, Claims, Customer Service, and Legal to ensure consistent interpretation and application of benefits and policies
• Partner with Claims, Customer Service, Billing & Eligibility, Marketing, Utilization Management, Professional Relations and Legal to ensure complete and fair reviews of complaints and appeals and consistent interpretation and application of benefits and policies.
• Oversee the timely, accurate handling of high-volume appeals, grievances and complaints in accordance with  regulatory and contractual deadlines.
• Serve as the primary point of contact for AZDIFI and Attorney General’s Office consumer complaints.
• Support responses to AZDIFI and Attorney General inquiries, ensuring accuracy, completeness and compliance.
• Ensure proper documentation, logging, tracking, reporting and closure of all cases across systems, including coordinating refunds, payments and adjustments as needed.
• Direct external independent reviews to AZDIFI or other external review organizations 
• Document records in accordance with AZDIFI guidance requirements
• Submit biannual Grievance Reports to the AZDIFI per statutory requirements.
• Manage monthly and quarterly appeal reports for group customers, as well as internal reporting.
• Attend Office of Administration Hearing (OAH) as needed

The pay range for this position is $62,300 - $89,100 per year. This position is fully remote. 

• Bachelor’s degree or equivalent experience
• 5+ years of experience resolving health care appeals, grievances or regulatory complaints
• Advanced knowledge of State and Federal laws, DIFI regulations, NCQA standards and group policies and procedures
• Solid analytical and problem-solving skills, with ability to identify trends and implement solutions
• Excellent verbal and written communication skills
• Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint
• Prior supervisory, training, or QA leadership experience preferred

About Us

Delta Dental of Arizona’s vision is simple: healthier lives for everyone. That’s why we’ve made it our mission to create a path to better health and wellness. We’re transforming from a single line insurance company to a multi-line health and wellness organization with a foundation that has awarded millions in grants to non-profits who care for our most vulnerable residents by offering dignity and hope.

Our employees enjoy competitive compensation and comprehensive benefits, including medical, dental, vision, 401(k), student loan assistance, six weeks of paid parental leave, volunteer PTO, and a culture that embraces collaboration, service, integrity, and inclusion.  At about 150 employees, we cultivate a work community where all employees are known by name, and everyone’s contributions are visible, noticed, and celebrated.  

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification form upon hire.