• Appeals and Grievance Specialist

    Commonwealth Care Alliance (Boston, MA)
    …the member experience. This position works collaboratively across many departments at Commonwealth Care Alliance (CCA) as well as externally to facilitate timely ... of updated data in Appeal/Grievance application of the member enrollment database system to ensure successful audit preparation; supports the review data for… more
    Commonwealth Care Alliance (05/21/25)
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  • Clinical Informaticist

    Commonwealth Care Alliance (Boston, MA)
    …support a data-driven performance culture. In addition, as experts in the system , our Clinical Informaticists serve as trusted advisors, brought into initial ... No **Essential Duties & Responsibilities** + Cultivate expert knowledge of CCA's systems used for clinical care, clinical operations, and care management ( systems… more
    Commonwealth Care Alliance (06/25/25)
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  • Member Service Rep

    Commonwealth Care Alliance (Boston, MA)
    …all member and prospective member interactions in a Centralized Electronic System . * Responsible for the scheduling of member appointments, transportation, ... appointments preferred * Ability to work with multiple computer programs and phone systems at once Required Knowledge, Skills & Abilities: * Must be passionate about… more
    Commonwealth Care Alliance (07/10/25)
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  • Manager, Consumer Participation & Engagement

    Commonwealth Care Alliance (Boston, MA)
    …healthcare. Improving care for these individuals is one of our healthcare system 's highest priorities, but meaningfully engaging these consumers in creating care ... systems that fulfill their needs is an unmet opportunity.**...Abilities (Required)** **Understanding of health plan operations and delivery system ** **Excellent group facilitator both virtually and in person**… more
    Commonwealth Care Alliance (07/16/25)
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  • Medical Policy Program Manager

    Commonwealth Care Alliance (Boston, MA)
    …+ Minimum 2 years' experience in the health care delivery system /industry or public health/public policy sector + Experience managing cross-functional projects ... Office products. Must have proven ability to learn new systems and databases that CCA implements. + Flexibility and...with internal and external partners + Ability to identify system problems and creatively facilitate processes to come up… more
    Commonwealth Care Alliance (05/31/25)
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  • Manager, Medical Policy

    Commonwealth Care Alliance (Boston, MA)
    …experience + Minimum 3 years' experience in the health care delivery system /industry or public health/public policy sector + 1-3 years' supervisory or managerial ... proficient in the use of PC and various claim systems + Must be proficient in the use of...and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants… more
    Commonwealth Care Alliance (05/31/25)
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  • MassHealth Regulatory Compliance & Audits…

    Commonwealth Care Alliance (Boston, MA)
    …works closely with Cognizant (TPA) to drive configuration changes, submit and track system change requests, and prepare for audits and regulatory reviews. This role ... all regulatory inquiries, escalations, and resolutions. Change Request Management & System Configuration * Draft detailed ServiceNow change requests in collaboration… more
    Commonwealth Care Alliance (06/02/25)
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  • Medicare/Medicaid Claims Editing Specialist

    Commonwealth Care Alliance (Boston, MA)
    …financial ability and forecasting for small to large Operations Management + Collaborate system and data configuration into CES (Claims Editing System ) with ... required + 7+ years experience with Optum Claims Editing System (CES), Zelis, Lyric or other editing tools +...and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants… more
    Commonwealth Care Alliance (05/28/25)
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  • Risk Adjustment Business Analyst

    Commonwealth Care Alliance (Boston, MA)
    …the employment of business requirements gathering, project management techniques, business systems analysis, and reporting using a variety of reporting platforms, ... systems , sources, and data formats. They will collaborate with...and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants… more
    Commonwealth Care Alliance (05/23/25)
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  • Appeals and Grievances Program Advisor

    Commonwealth Care Alliance (Boston, MA)
    …(and other department audits as necessary) by using Adobe to combine and label system screen shots and case letters based on detailed audit regulations. + Assist in ... of updated data in Appeal/Grievance application of the member enrollment database system to ensure successful audit preparation; supports the review data for… more
    Commonwealth Care Alliance (06/06/25)
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