Clinical Appeals & Grievances Specialist

Point32Health, Inc.; Milton (MA); On-site; USD 60,000 - 75,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement plans

Life and disability insurance

Well-being benefits

Career development benefits

Job summary

Point32Health, Inc. is seeking a motivated professional to support Appeals & Grievances processes within a managed care environment focused on Commercial plans and Medicaid.

The role serves as a clinical resource for various aspects of A&G work and supports analysts with knowledge development of medical terminology and provider plans of care relative to appeals. Responsibilities include assisting with new hire training on clinical aspects of A&G and contributing to other departmental projects as

Qualifications

• Understanding of Appeals & Grievances processes in managed care, with focus on Commercial plans and Medicaid.
• Ability to support knowledge development of medical terminology and provider plans of care related to appeals.

Responsibilities

• Support Analyst team in developing knowledge of medical terminology and provider plan of care for appeals.
• Assist department trainer with new hire training relating to clinical aspects of Appeals & Grievances work.
• Perform other duties and projects as assigned.

Job description

Point32Health, Inc. is seeking a motivated professional to support Appeals & Grievances processes within a managed care environment focused on Commercial plans and Medicaid.

The role serves as a clinical resource for various aspects of A&G work and supports analysts with knowledge development of medical terminology and provider plans of care relative to appeals. Responsibilities include assisting with new hire training on clinical aspects of A&G and contributing to other departmental projects as