Duals Supervisor, Appeals and Grievances - Somerville, MA

+The Appeals and Grievance Coordinator will coordinate, process, and document all aspects of member appeals and grievances, · as well as provider appeals across all our product offerings (Commercial, Medicaid and Medicare). · ...

+ Job Summary · The role leads a team responsible for the processing of all Member Appeals and Grievances for Medicaid and Commercial product lines. · + Qualifications:Bachelor's Degree or the equivalent combination of training and experience required · + ...

The Appeals & Grievances Lead oversees the daily operations and performance of the Appeals & Grievances program. · Oversee workflow management to ensure cases are processed accurately and within required turnaround times · Ensure compliance with state and federal standards and in ...

The role leads a team responsible for the processing of all Member Appeals and Grievances for Medicaid and Commercial product lines. · Oversight includes appeal and grievance intake, investigation, and resolution. · Create systems and procedures for operating efficiency. · ...

The incumbent will coordinate, process, and document all aspects of member appeals and grievances across our product offerings. Responsible for documenting and owning the life cycle of all member appeals and grievances and provider appeals. · ...

The Appeals and Grievances Coordinator will coordinate process and document all aspects of member appeals grievances as well as provider appeals across all our product offerings Commercial Medicaid Medicare. · Bachelor's Degree Related Field of Study preferred · ...

Who We Are · Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to prov ...

The Duals Supervisor, Appeals and Grievances provides day-to-day supervision of a team of 4-6 appeals and grievance coordinators and is ultimately responsible for the work product of this team and the Duals line of business. · The Supervisor oversees all aspects of the Appeal and ...

The role ensures clinical/pharmacy appeal case reviews meet contractual regulatory and business goals by collaborating with team members pharmacy team medical director teams to resolve all types of clinical issues across the clinical/pharmacy appeal landscape. · In conjunction wi ...

The Duals Supervisor Appeals Grievances provides day-to-day supervision of a team of 4-6 appeals and grievance coordinators.• Facilitates regular bi-weekly one-on-one meetings and weekly team staff meetings with the Appeals and Grievances department. · • Identifies training needs ...

The role is an integral part of our Appeals and Grievance review process and will ensure clinical/pharmacy appeal case reviews meet contractual, regulatory, and business goals. Essential Functions · • In conjunction with other appeal team members, ensures that clinical/pharmacy a ...

The role is an integral part of our Appeals and Grievance review process and will ensure clinical/pharmacy appeal case reviews meet contractual, regulatory, and business goals. · Bachelor's Degree required. · ...

The Duals Supervisor, Appeals and Grievances provides day-to-day supervision of a team of 4-6 appeals and grievance coordinators. · The Supervisor oversees all aspects of the Appeal and Grievance processes in accordance with the Massachusetts Division of Insurance and Executive O ...

The Clinical Appeal and Grievance Nurse role is an integral part of our Appeals and Grievance review process ensuring clinical/pharmacy appeal case reviews meet contractual, · regulatory, · and business goals.In conjunction with other appeal team members ensures that clinical/pha ...

Join our client's team as an Appeals & Grievances Coordinator and play a vital role in ensuring seamless resolution processes for member grievances and appeals within our innovative health plan. · Manage a high volume of incoming grievances and appeals from initiation to resoluti ...

The Member Appeals and Grievance Analyst is responsible for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. · This individual works collaboratively with the member and/or the member's auth ...

Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals and grievance (complaints ...

+Join our client's team as an Appeals & Grievances Coordinator and play a vital role in ensuring seamless resolution processes for member grievances and appeals within our innovative health plan. · +Manage a high volume of incoming grievances and appeals from initiation to resolu ...

Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals and grievance (complaints ...

· Company Overview:  · Join us in our mission to transform healthcare nirvanaHealth (under RxAdvance Corp.) is committed to bringing the art of the possible to the payer and PBM industries. We invest in our employees at every stage of life. Success radiates across all levels of ...