Member Appeals & Grievances Coordinator — Data & Insights

WellSense Health Plan; Boston (MA); Sur place; USD 28 000 - 39 000; Plein temps

Avantages offerts par ce poste

Medical, dental, vision benefits

403(b) savings match

Paid time off

Flexible Spending Accounts

Career advancement opportunities

Wellbeing resources

Résumé du poste

WellSense Health Plan is seeking a detailed-oriented Member Appeals and Grievances Coordinator in the Boston area. The role focuses on intake and routing of member appeals and grievances, accurate data entry, and maintaining secure records in the A&G system.

You will work with multiple teams to ensure timely responses and compliance. Responsibilities include trend reporting, audits, and training support for new staff while meeting deadlines and providing high-quality member service in a

Qualifications

• Bachelor’s degree in Health Care Administration, related field, or equivalent combination of education, training and experience.
• Experience with Microsoft Office and healthcare management systems.
• Ability to identify problems, collect data, and draw valid conclusions.

Responsabilités

• Identify and intake appeals and grievances in a compliant, timely manner.
• Enter data accurately into the A&G system of record and distribute to specialists.
• Maintain organized record keeping and respond to inquiries from other departments.
• Generate daily/weekly/monthly reports for management audits and monitoring.
• Collaborate with A&G leadership and staff; participate in training as needed.

Connaissances

Microsoft Office Applications

Proprietary healthcare management sys

Problem solving

Formation

Bachelor’s degree in Health Care Administration

Outils

JIVA

Express Scripts

HPMS

Access

Description du poste

WellSense Health Plan is seeking a detailed-oriented Member Appeals and Grievances Coordinator in the Boston area. The role focuses on intake and routing of member appeals and grievances, accurate data entry, and maintaining secure records in the A&G system.

You will work with multiple teams to ensure timely responses and compliance. Responsibilities include trend reporting, audits, and training support for new staff while meeting deadlines and providing high-quality member service in a