Associate Director, Appeals & Grievances (Healthcare)

Location: Remote, open only to candidates residing in Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, North Carolina, Ohio, California, Pennsylvania, South Carolina, Tennessee, Texas, or Virginia. Occasional travel may be required for team meetings and company events.

Base pay: $123,372–$161,925.75 per year in California, Connecticut, New Jersey, New York, and Washington; $111,034.80–$145,733.18 per year in all other locations.

Company

hirify.global is a health insurance company built around a full-stack technology platform and a focus on serving members.

What you will do

• Lead operational goals for administrative complaints, grievances, appeals, and escalation teams across all lines of business.
• Build and develop managers, leads, and specialists through structured coaching and performance accountability.
• Resolve high-visibility and high-risk administrative complaints from senior leadership, regulators, and social channels.
• Establish standardized evaluation, escalation, and resolution workflows for end-to-end case ownership.
• Maintain audit readiness and lead CMS, state Department of Insurance, and internal compliance audits.
• Partner with Claims, Network, Legal, and Compliance to address root causes, improve efficiency, and manage delegated vendors.

Requirements

• 7+ years of progressive experience in healthcare operations focused on compliance, complaints, grievances, or appeals.
• 4+ years of people management experience in a high-volume operations environment.
• Advanced knowledge of Commercial Insurance, Medicare/Medicaid, and ACA rules governing administrative grievance and appeals processes.
• Experience leading or representing operational teams during CMS, state-level, or other regulatory audits.
• Experience using operational data for decision-making, capacity management, and process improvement.

Nice to have

• Bachelor's degree or equivalent experience.
• Lean Six Sigma Green Belt, Black Belt, or equivalent operational excellence certification.
• Experience leading remote or multi-site teams.
• Experience with Tableau, Looker, Inovaare, Jira, or similar tools.
• Advanced degree such as an MBA, Master of Health Administration, or Juris Doctor.

Culture & Benefits

• Full-time employment with medical, dental, and vision benefits.
• Unlimited vacation program, 11 paid holidays, paid sick time, and paid parental leave.
• 401(k) participation, life and disability insurance, paid wellness time, and reimbursements.
• Annual performance bonuses.
• Equal opportunity environment focused on belonging and support.