2-4 years customer service experience in healthcare
Knowledge of ncqa, doi, cms, dol regulations
Ability to work remotely from home
Harvard Pilgrim Health Care Inc is seeking an Appeals and Grievance Analyst for a fully remote position. The role focuses on managing member appeals and grievances in compliance with State and Federal regulations while providing superior customer service
Job Summary
The role involves managing member appeals and grievances while ensuring strict compliance with state and federal regulations.
Point32Health is a leading not-for-profit organization dedicated to delivering high-quality, affordable healthcare to nearly 2 million members.
Employees are eligible for a comprehensive total rewards package including medical, dental, vision, retirement plans, and paid time off.
Matching Summary
Match Score: 85
Harvard Pilgrim Health Care Inc is seeking an Appeals and Grievance Analyst for a fully remote position. The role focuses on managing member appeals and grievances in compliance with State and Federal regulations while providing superior customer service.
Salary
Base: $22.96 - $34.45 per hour; Bonus/Equity: Variable pay eligibility mentioned; Benefits: Medical, dental, vision, retirement, PTO included
Skills & Requirements
Must-have
2-4 years customer service experience in healthcare
Knowledge of NCQA, DOI, CMS, DOL regulations
Ability to work remotely from home
Strong written and verbal communication skills
Experience with Windows applications and systems
Nice-to-have
Bachelor's degree in related field
Prior appeals and grievance experience
Empathy and community-focused mindset
Ability to handle escalated issues
Collaborative team player
Key Requirements
Associate's Degree or equivalent experience required
2-4 years' experience as customer service representative
Preferred: 2 years' Appeals and Grievance experience