Grievance/Appeals Representative I - Woburn

The Grievance/Appeals Representative I will be responsible for reviewing, analyzing and processing claims in accordance with policies and claims events to determine the extent of the company's liability and entitlement. · A comprehensive benefits package. · ...

This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity. · ...

+Job summary · This role requires associates to be in-office - 2 days per week. · The Grievance/Appeals Representative I is responsible for reviewing, analyzing and processing member complaints in accordance with policies and claims events to determine the extent of the company's ...

This role combines structured office engagement with virtual work flexibility. · The Grievance/Appeals Representative I reviews customer complaints and processes claims according to policies. · Conducts investigations and researches policy provisions. · Gathers information from c ...

The Grievance/Appeals Representative I will review analyze and process claims in accordance with policies and claims events to determine the extent of the company's liability and entitlement. · This role requires associates to be in-office 1-2 days per week fostering collaboratio ...

+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 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 · ...

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 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 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. · ...

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 ...

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 ...

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 ...

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... · Analysts routinely interact with members about highly escalated ...

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 ...

We are currently looking for an Appeals and Grievance Analyst to join our team at Point32Health. As an Appeals and Grievance Analyst you will be responsible for managing member appeals and grievances in accordance with State and Federal regulations. · You will work collaborativel ...

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

· 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 ...