Clinical Appeals Strategist

P32HS Point32Health Services Inc; Massachusetts; Hybride; USD 90 000 - 120 000; Plein temps

Avantages offerts par ce poste

Medical coverage

Dental coverage

Vision coverage

Retirement plans

Paid time off

Tuition program

Well-being benefits

Résumé du poste

Point32Health is seeking a Clinical Consultant for Appeals & Grievances to support clinical aspects of the A&G program and act as a liaison with internal teams and vendors. The role emphasizes independent work, clinical knowledge, and collaboration to improve member outcomes.

The position requires expertise in managed care appeals, strong medical terminology, and the ability to work across departments to resolve issues and drive improvements in member satisfaction.

Qualifications

• Experience with appeals and grievances processes in managed care.
• Ability to analyze medical terminology and provider plans of care.
• Experience coordinating with cross-functional teams.

Responsabilités

• Serve as clinical resource for Appeals & Grievances work.
• Support Analysts in medical terminology and plan of care review.
• Identify complex members and refer to case management.
• Assess drivers of appeals and suggest messaging to stakeholders.
• Consult with MD reviewers on complex appeals.
• Assist with training and other duties.

Connaissances

Clinical knowledge

Team collaboration

Independent work

Medical terminology

Description du poste

Point32Health is seeking a Clinical Consultant for Appeals & Grievances to support clinical aspects of the A&G program and act as a liaison with internal teams and vendors. The role emphasizes independent work, clinical knowledge, and collaboration to improve member outcomes.

The position requires expertise in managed care appeals, strong medical terminology, and the ability to work across departments to resolve issues and drive improvements in member satisfaction.