Appeals And Grievance Analyst

Harvard Pilgrim Health Care Inc

Canton, MA, United States
Base: $23.02 - $34.53 ph; bonus/equity: variable p...
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2-4 years customer service experience
Knowledge of ncqa, doi, cms, dol regulations
Ability to work under tight regulatory timelines
** Point32Health is seeking an Appeals and Grievance Analyst to manage member appeals and grievances in compliance with State and Federal regulations. The ideal candidate will have a background in healthcare customer service, strong analytical skills, and a commitment to advocacy for members. **

Job Summary

  • The role involves managing member appeals and grievances while ensuring strict compliance with NCQA, DOI, CMS, and DOL regulations.
  • Point32Health is a leading not-for-profit organization dedicated to delivering high-quality healthcare to nearly 2 million members.
  • Candidates will act as member advocates, interpreting benefit designs and coordinating complex investigations to reach compliant resolutions.

Matching Summary

Match Score: 75

** Point32Health is seeking an Appeals and Grievance Analyst to manage member appeals and grievances in compliance with State and Federal regulations. The ideal candidate will have a background in healthcare customer service, strong analytical skills, and a commitment to advocacy for members. **

Salary

Base: $23.02 - $34.53 per hour; Bonus/Equity: Variable pay eligible; Benefits: Medical, dental, vision, retirement, PTO, tuition program

Skills & Requirements

Must-have

  • 2-4 years customer service experience
  • Knowledge of NCQA, DOI, CMS, DOL regulations
  • Ability to work under tight regulatory timelines
  • Strong written and verbal communication skills
  • Experience reviewing medical and claims records

Nice-to-have

  • Prior appeals and grievance experience
  • Bachelor's degree in related field
  • Empathy and community-focused mindset
  • Ability to collaborate with subject matter experts
  • Flexibility for rotating weekend coverage

Key Requirements

  • Associate's Degree or equivalent experience
  • 2-4 years healthcare customer service experience
  • Preferred: 2 years Appeals and Grievance experience
  • Proficiency in Windows applications and systems

Work Rights

Not specified

Tailored Resume

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