"Alerted.org

Job Title, Industry, Employer
City & State or Zip Code
20 mi
  • 0 mi
  • 5 mi
  • 10 mi
  • 20 mi
  • 50 mi
  • 100 mi
Advanced Search

Advanced Search

Cancel
Remove
+ Add search criteria
City & State or Zip Code
20 mi
  • 0 mi
  • 5 mi
  • 10 mi
  • 20 mi
  • 50 mi
  • 100 mi
Related to

  • Supervisor, Appeals and Grievances

    Point32Health (MA)



    Apply Now

    Who We Are

     

    Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

     

    We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health (https://www.point32health.org/) .

    Job Summary

    Under the general direction of the Manager, Appeals and Grievances the Supervisor, Appeals and Grievances using in depth knowledge of Plan benefits and regulatory requirements, will coordinate and provide leadership for the daily operations of the Appeals and Grievances department. The supervisor represents the Appeals and Grievances Department and the Plan when working with review agencies (Office of Patient Protection / OPP), accreditation agencies (National Committee for Quality Assurance / NCQA and Centers for Medicare & Medicaid Services / CMS), providers, high profile employer groups (Group Insurance Commission / GIC and US Family Health Plan / USFHP). Internally, he/she is responsible for many cross department and divisional interfaces (i.e., advising case managers in the field, responding to requests from sales). The supervisor routinely deals with escalated issues, the supervisor must demonstrate strong professional judgment and apply risk management in highly escalated situations. The supervisor is also responsible for team management, individual analyst productivity, staff development, staffing and communication.

    Job Description

    Key Responsibilities/Duties – what you will be doing (top five):

    + Provide oversight of the day-to-day operations of assigned team of Analysts and Coordinators and ensure all cases are processed timely.

    + Work with Manager to ensure that employees have the requisite information and knowledge of regulatory issues and requirements to carry out their responsibilities.

    + Coach, develop, and mentor staff in the accurate and timely management of Appeals and Grievances.

    + Partner with the Appeals and Grievances Program Management Team to ensure compliance.

    + Ensure delivery of optimal customer services by working cross functionally with internal business units and external partners.

    + Perform other duties and projects as assigned.

     

    Qualifications – what you need to perform the job

     

    Certification and Licensure

    Education

    + Required (minimum): BA/BS or equivalent experience in health care, conflict resolution or related field

    + Preferred:

    Experience

    + Required (minimum): 4–6 years of Appeals and Grievance experience.1-2 years of prior supervisor experience; health care benefit and regulatory knowledge of insurance products, policies, and procedures. Prior leadership experience required, including mentoring and developing associates to support their professional growth and team success.

    + Preferred: None listed

    Skill Requirements

    + Strong ability to positively influence others and effectively drive change, fostering a supportive and constructive environment while implementing initiatives.

    + Strong personal accountability and a commitment to fostering accountability within the team are essential for success in this role. You will be expected to take ownership of both individual and team performance, ensuring that goals are met, and challenges are addressed proactively.

    + Must be highly organized and self-directed, with proven ability to work independently and in team settings.

    + Demonstrated ability to synthesize and process complex information and deliver the information, both verbally and written, in a clear, concise, and articulate manner.  Requires strong verbal and written skills to effectively communicate at both detail and summary levels to Point32Health management.

    + Requires excellent interpersonal skills to communicate and work with staff of all skill and experience levels. Must be able to exercise patience and high level of diplomacy to recognize politically sensitive issues.

     

    Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

     

    + Must be able to work under normal office conditions and work from home as required.

    + Must be able to manage a remote workforce.

    + Work requires simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.

    + May be required to work additional hours beyond standard work schedule.

    + Weekend Coverage may be required on a rotating basis as regulated for line of business.

    + Must be available to assist with mailing of member and provider documents, frequent travel will be required. This involves printing letters and dropping them off at UPS/USPS.

    + Valid driver’s license and reliable transportation required.

     

    Disclaimer

     

    The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

     

    Compensation & Total Rewards Overview

     

    As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

    Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

    + Medical, dental and vision coverage

    + Retirement plans

    + Paid time off

    + Employer-paid life and disability insurance with additional buy-up coverage options

    + Tuition program

    + Well-being benefits

    + Full suite of benefits to support career development, individual & family health, and financial health

     

    For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

     

    We welcome all

     

    All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

     

    **Scam Alert** : Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact [email protected]

     

    Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

     


    Apply Now



Recent Searches

[X] Clear History

Recent Jobs

  • Supervisor, Appeals and Grievances
    Point32Health (MA)
  • Ecosystem Portfolio Specialist - Charlotte Metro
    Novo Nordisk Inc. (Charlotte, NC)
  • Independent Advocate
    SingleCare LLC (Cheyenne, WY)
  • Lecturer in Finance
    University of Colorado (Denver, CO)
[X] Clear History

Account Login

Cancel
 
Forgot your password?

Not a member? Sign up

Sign Up

Cancel
 

Already have an account? Log in
Forgot your password?

Forgot your password?

Cancel
 
Enter the email associated with your account.

Already have an account? Sign in
Not a member? Sign up

© 2025 Alerted.org