Tufts Health Plan
Appeals and Grievance Analyst
This job is now closed
Job Description
- Req#: R7400
Employer Industry: Health Insurance
Why Consider this Job Opportunity:
- Competitive salary range from $53,079 to $68,691
- Comprehensive benefits package including medical, dental, and vision coverage
- Retirement plans and employer-paid life and disability insurance
- Tuition program for career development
- Emphasis on diversity, equity, inclusion, accessibility, and health equity
- Opportunity to work for a leading health and wellbeing organization with a nonprofit heritage
What to Expect (Job Responsibilities):
- Serve as a member advocate, explaining the appeal and grievance process
- Manage member appeals and grievances from documentation to resolution, ensuring compliance with regulations
- Review and interpret product and benefit designs for all lines of business
- Collect and analyze necessary documents and records for research
- Make recommendations on appeal decisions based on member benefits and circumstances
What is Required (Qualifications):
- Associates Degree or equivalent experience in healthcare, conflict resolution, or related field
- 3-5 years of healthcare or insurance experience
- Proficiency in computer operations and Windows applications
- Strong communication and interpersonal skills
- Ability to work independently and collaboratively
How to Stand Out (Preferred Qualifications):
- Knowledge of health insurance products, policies, and procedures
- Experience with health care benefits and regulatory knowledge
#HealthInsurance #CompetitiveSalary #CareerDevelopment #DiversityEquityInclusion #HealthEquity
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Tufts Health Plan is a Massachusetts-based health insurance company under Tufts Associated Health Plans, Inc.
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