Guiding and empowering healthier lives for everyone.

Appeals and Grievance Analyst

AnalystAnalystFull TimeRemoteTeam 1,001-5,000H1B No SponsorCompany Site LinkedIn

Location

Massachusetts

Posted

19 days ago

Salary

$23 - $34 / hour

Associate DegreeEnglish

Job Description

• Act as a member advocate; clearly communicating the appeal and grievance process and procedures • Manage assigned member appeals and grievance cases from documentation, investigation, and through resolution • Ensure compliance with regulatory requirements during final disposition • Review product and benefit designs according to regulations • Consult with subject matter experts for resolution of matters

Job Requirements

Strong customer service and benefit interpretation skills
Ability to manage assigned member appeals and grievance cases
Knowledge of NCQA, DOI, CMS, DOL and state or federal specific regulations
Ability to review and interpret product and benefit designs
Experience in collecting documents and records for appeals

Benefits

Medical, dental and vision coverage
Retirement plans
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Full suite of benefits to support career development, individual & family health, and financial health