Remote Appeals & Grievances Specialist

Point32Health, Inc.; Canton (MA); Hybrid; USD 61,091,000 - 91,635,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Retirement plans

Paid time off

Life insurance

Disability insurance

Tuition program

Well-being benefits

Job summary

Point32Health, Inc. is seeking an Appeals and Grievance Coordinator to manage day-to-day tasks within the A&G department. You will process mail, assign cases, and support analysts while ensuring compliance with regulatory timelines.

The role requires 1-2 years of relevant experience, strong organizational and communication skills, and proficiency in Excel and Word. A work-from-home option may be available as needed, with some on-site work in the Canton area.

Qualifications

• Associate’s degree or equivalent experience in health care, conflict resolution, or related field.
• 1-2 years of member services representative/customer service experience in health care.
• 1-2 years’ Appeals and Grievance experience in assigning and handling appeals and grievances.

Responsibilities

• Assign new verbal and written appeals and grievances to Appeals and Grievances Analyst.
• Support A&G Analyst in timely completion of Appeals and Grievances.
• Adheres to all regulatory, internal and compliance timeliness expectations.
• Distribution of incoming mail as well as department manual mail processing.
• Other duties and projects as assigned.

Skills

Organizational skills

Communication skills

Excel

Word

Windows applications

Education

Associate’s Degree or equivalent

Job description

Point32Health, Inc. is seeking an Appeals and Grievance Coordinator to manage day-to-day tasks within the A&G department. You will process mail, assign cases, and support analysts while ensuring compliance with regulatory timelines.

The role requires 1-2 years of relevant experience, strong organizational and communication skills, and proficiency in Excel and Word. A work-from-home option may be available as needed, with some on-site work in the Canton area.