Clinical Appeals Consultant Grievances

Point32Health, Inc.; Oklahoma City (OK); On-site; USD 100,000 - 130,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement plans

Paid time off

Life and disability insurance

Tuition program

Well-being benefits

Job summary

Point32Health, Inc. is seeking a Clinical Consultant – Appeals & Grievances to support the Appeals & Grievances team, providing clinical input and acting as liaison with providers and internal partners.

You will analyze complex cases, advise on physician review needs, and help develop consistent messaging for member and vendor escalations, with focus on commercial and Medicaid plans. This role requires independent work, strong collaboration, and a deep understanding of managed care processes

Responsibilities

• Provide clinical input for appeals and grievances decisions.
• Serve as liaison with internal departments and providers on clinical issues.
• Assist with responses to escalated member and provider issues.

Job description

Point32Health, Inc. is seeking a Clinical Consultant – Appeals & Grievances to support the Appeals & Grievances team, providing clinical input and acting as liaison with providers and internal partners.

You will analyze complex cases, advise on physician review needs, and help develop consistent messaging for member and vendor escalations, with focus on commercial and Medicaid plans. This role requires independent work, strong collaboration, and a deep understanding of managed care processes