- 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 ... responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for… more
- Highmark Health (Boston, MA)
- …they meet the definition of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals ; initiates a case file for each grievance ... parties. + Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross functional… more
- Evolent (Boston, MA)
- …supporting Evolent's clinical services (ie, specialty care, utilization management, care management, appeals & grievances ) + Using analytical tools to integrate ... 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… more
- Commonwealth Care Alliance (Boston, MA)
- …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, and timely reimbursements… more