- Point32Health (Watertown, MA)
- …the general direction of the Member Appeals and Grievance Supervisor the 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) received by Point32Health. This individual works… more
- Highmark Health (Boston, MA)
- …of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals ; initiates a case file for each grievance and appeal; ensures ... all involved parties. + Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross… more
- Point32Health (MA)
- …colleagues and communities. **Job Summary** Under the general direction of the Manager, Appeals and Grievances the Supervisor, Appeals and Grievances using in ... requirements, will coordinate and provide leadership for the daily operations of the Appeals and Grievances department. The supervisor represents the Appeals and… more
- Evolent (Boston, MA)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** ** Analyst , Client Analytics** Integrate and analyze claims and enrollment data from multiple ... Evolent's clinical services (ie, specialty care, utilization management, care management, appeals & grievances) + Using analytical tools to integrate various data… more
- Commonwealth Care Alliance (Boston, MA)
- …to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, and timely reimbursements ... issues - including underpayments, overpayments, and disputes. The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare,… more