Massachusetts Licensed Appeals Analyst

Job Summary

A company is looking for an Appeals and Grievance Analyst.

Key Responsibilities

• Act as a member advocate, communicating the appeal and grievance process clearly
• Manage assigned member appeals and grievances, ensuring compliance with regulatory requirements
• Review and interpret product and benefit designs in accordance with State and Federal regulations

Required Qualifications, Training, and Education

• Experience in managing appeals and grievances in a healthcare setting
• Knowledge of State and Federal regulatory requirements (NCQA, DOI, CMS, DOL)
• Ability to collect and analyze documentation related to appeals and grievances
• Experience in consulting with subject matter experts for resolution of issues
• Strong understanding of healthcare products and benefits