Massachusetts Licensed Appeals Manager

Job Summary

A company is looking for a Manager, Appeals & Grievances.

Key Responsibilities

• Oversee all processes related to the intake, triaging, coordination, and documentation of all appeals and grievances
• Ensure compliance with state and federal regulations while maintaining quality control processes
• Present appeal and grievance reports to internal stakeholders and act as a liaison for audits and regulatory matters

Required Qualifications

• Bachelor's degree or equivalent combination of training and experience, plus 5-7 years of related experience
• Registered nurse preferred
• At least 5-7 years of experience in appeals and grievances
• 2-3 years of experience in a supervisory or management role
• Knowledge of Medicaid, Medicare, and Commercial insurance