Appeals And Grievance Analyst

Harvard Pilgrim Health Care Inc

9 Locations
Base: $22.92 - $34.38 ph; bonus/equity: variable p...
Fully remote
2-4 years customer service experience in healthcare
Knowledge of ncqa, doi, cms, dol regulations
Ability to interpret health care benefit designs
Point32Health is seeking an Appeals and Grievance Analyst to manage and coordinate member appeals and grievances in compliance with state and federal regulations. The ideal candidate will have experience in customer service within the healthcare or insurance sectors, with strong analytical and communication skills

Job Summary

  • The role involves managing member appeals and grievances in compliance with state and federal regulations such as NCQA, DOI, CMS, and DOL.
  • Candidates must demonstrate superior customer service skills while acting as a member advocate and interpreting complex benefit designs.
  • Point32Health offers a comprehensive total rewards package including medical, dental, vision, retirement plans, and paid time off.

Matching Summary

Match Score: 85

Point32Health is seeking an Appeals and Grievance Analyst to manage and coordinate member appeals and grievances in compliance with state and federal regulations. The ideal candidate will have experience in customer service within the healthcare or insurance sectors, with strong analytical and communication skills.

Salary

Base: $22.92 - $34.38 per hour; Bonus/Equity: Variable pay eligible; Benefits: Medical, dental, vision, retirement, PTO, life/disability insurance

Skills & Requirements

Must-have

  • 2-4 years customer service experience in healthcare
  • Knowledge of NCQA, DOI, CMS, DOL regulations
  • Ability to interpret health care benefit designs
  • Strong written and verbal communication skills
  • Experience with Windows applications and systems

Nice-to-have

  • Bachelors degree in related field
  • Prior appeals and grievance experience
  • Knowledge of insurance products and policies
  • Demonstrated initiative and balanced judgment
  • Ability to work independently and collaborate

Key Requirements

  • Associate's Degree or equivalent experience required
  • 2-4 years healthcare customer service experience
  • Preferred: Bachelors Degree in related field
  • Preferred: 2 years Appeals and Grievance experience
  • Must be able to work from home and handle rotating weekend coverage

Work Rights

Not specified

Tailored Resume

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