Appeals & Grievances Case Manager

Mass Digital Health; Southborough (MA); On-site; USD 55,000 - 70,000; Full time

Job summary

Mass Digital Health in Massachusetts is seeking an Appeals & Grievances Coordinator to help support the intake, review, and resolution of member and provider appeals and grievances. You'll work closely with various teams while ensuring compliance with CMS-mandated timelines and executing case management processes.

The ideal candidate will have 1-3 years of related experience, strong professional writing skills, and familiarity with CMS regulations. This position requires detail orientation and effective communication across teams.

Qualifications

• 1–3 years of related experience in Appeals & Grievances case management.
• Familiarity with CMS guidance and Medicare Part C & D regulations.
• Strong professional writing skills for drafting letters.

Responsibilities

• Manage cases end-to-end for member and provider appeals and grievances.
• Draft clear and compliant member-facing communications.
• Collaborate with cross-functional teams to build complete case folders.

Skills

Critical thinking

Detail orientation

Effective verbal communication

Strong professional writing skills

Education

Bachelor's degree or equivalent experience

Tools

Microsoft Office (Excel, Word, Outlook)

Job description

Mass Digital Health in Massachusetts is seeking an Appeals & Grievances Coordinator to help support the intake, review, and resolution of member and provider appeals and grievances. You'll work closely with various teams while ensuring compliance with CMS-mandated timelines and executing case management processes.

The ideal candidate will have 1-3 years of related experience, strong professional writing skills, and familiarity with CMS regulations. This position requires detail orientation and effective communication across teams.