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Jobs at Point32Health, Inc.

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\u2019ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it\u2019s 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. <\/p>
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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<\/a>.<\/p> <\/p> Job Summary<\/b><\/p>The Sr Community Outreach Representative - Duals will be highly visible in the 65+ Community to promote Point32Health, Duals Plan (Point32Health Duals) and its benefits that lead to the enrollment of new members. Education will be given to prospects and their care givers, Community Health Centers, Providers, local Elder Services, Councils on Aging, Housing Authorities, Senior Centers, and SHINE Counselors. The primary objective of this position is to identify prospective Duals-eligible members, explain the features and benefits of the plan in an assigned territory\/marketplace, and assist with enrollment into the plan. Successful candidates generate leads from a variety of sources including networking, account management, grassroots sources as well as from member referrals. <\/p> Job Description <\/b><\/p> <\/p> <\/p> Compensation & Total Rewards Overview<\/b><\/p> 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\u2019s sole discretion, consistent with the law.<\/p> <\/p> Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:<\/p> Medical, dental and vision coverage<\/p><\/li> Retirement plans<\/p><\/li> Paid time off<\/p><\/li> Employer-paid life and disability insurance with additional buy-up coverage options<\/p><\/li> Tuition program<\/p><\/li> Well-being benefits<\/p><\/li> Full suite of benefits to support career development, individual & family health, and financial health<\/p><\/li><\/ul> For more details on our total rewards programs, visit https:\/\/www.point32health.org\/careers\/benefits\/<\/a><\/p> <\/p> We welcome all<\/b> <\/p> Scam Alert<\/b>: 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 TA_operations@point32health.org<\/a><\/p> <\/p>
Key Responsibilities\/Duties \u2013 what you will be doing (top five):
\u2022 Effectively present the Point32Health Duals Program and its benefits to the 65+ MassHealth populations residing in the Community.
\u2022 Meet or exceed enrollment goals within an assigned territory; using a full sales mix of outreach & sales activities Conduct group and\/or individual sales presentations and enroll eligible prospects on site as often as possible
\u2022 Primary activities include community-based lead generation, developing partnership-based relationships with providers, community-based-organizations, senior housing, senior centers, advocacy agencies, etc. Other outreach & sales activities include conducting sales meetings, in-houses, conversion meetings, lead meetings, special events, developing referrals and having regular business reviews with accounts.
\u2022 Perform lead follow up and qualification calls to interested individuals to explain the purpose and benefits of Point32Health Duals and scheduling home visits to meet with prospects.
\u2022 Maintain lead tracking and sales database for all sales activity and consumer interactions performed.
\u2022 Submit completed enrollment applications on a timely basis.
\u2022 Coordinate and develop relationships with key community groups to allow Point32Health Duals to participate in community-sponsored events.
\u2022 Represent Point32Health Duals at community\/company-sponsored events to promote the company and the plan, raise awareness, network, and generate leads.
\u2022 Provide weekly activity plans, result summaries and monthly expense reports.
\u2022 Know provider networks (physician, hospital, and pharmacy) within assigned territories.
\u2022 Maintain good working knowledge of competitor products in the market
\u2022 Represent Point32Health Duals in a manner consistent with stated company values and departmental Code of Ethics
\u2022 Adhere to company and departmental policies and procedures, including abiding to all CMS and EOHHS guidelines.
\u2022 100% compliance with completion of all required certifications, licensing, continued education, policy acknowledgement and work plan documents within dates of completion requirements.
\u2022 Submit completed enrollment applications on a timely basis
\u2022 Successfully complete annual product training, AHIP certification and additional training and\/or certification that may be required
\u2022 Perform other duties as necessary and assigned
\u2022 Other duties and projects assigned.
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.<\/p>

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\u2019ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it\u2019s 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. <\/p>
<\/p>
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<\/a>.<\/p> <\/p> Job Summary<\/b><\/p>Educate and be highly visible in the 65+ Community to promote Point32Health, Senior Care Options Plan (Point32Health SCO) and its benefits that lead to the enrollment of new members. Education will be given to prospects and their care givers, Community Health Centers, Providers, local Elder Services, Councils on Aging, Housing Authorities, Senior Centers, and SHINE Counselors. The primary objective of this position is to identify prospective SCO-eligible members, explain the features and benefits of the plan in an assigned territory\/marketplace, and assist with enrollment into the plan. Successful candidates generate leads from a variety of sources including networking, account management, grassroots sources as well as from member referrals. <\/p> Job Description <\/b><\/p> Key Responsibilities\/Duties \u2013 what you will be doing (top five):<\/p> Qualifications \u2013 what you need to perform the job<\/p> Certification and Licensure<\/p> Education<\/p> Experience<\/p> Skill Requirements<\/p> Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):<\/p> Disclaimer<\/p> 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.<\/p> <\/p> <\/p> Compensation & Total Rewards Overview<\/b><\/p> 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\u2019s sole discretion, consistent with the law.<\/p> <\/p> Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:<\/p> Medical, dental and vision coverage<\/p><\/li> Retirement plans<\/p><\/li> Paid time off<\/p><\/li> Employer-paid life and disability insurance with additional buy-up coverage options<\/p><\/li> Tuition program<\/p><\/li> Well-being benefits<\/p><\/li> Full suite of benefits to support career development, individual & family health, and financial health<\/p><\/li><\/ul> For more details on our total rewards programs, visit https:\/\/www.point32health.org\/careers\/benefits\/<\/a><\/p> <\/p> We welcome all<\/b> <\/p> Scam Alert<\/b>: 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 TA_operations@point32health.org<\/a><\/p> <\/p>
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.<\/p>

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\u2019ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it\u2019s 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. <\/p>
<\/p>
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<\/a>.<\/p> <\/p> Job Summary<\/b><\/p>Educate and be highly visible in the 65+ Community to promote Point32Health, Senior Care Options Plan (Point32Health SCO) and its benefits that lead to the enrollment of new members. Education will be given to prospects and their care givers, Community Health Centers, Providers, local Elder Services, Councils on Aging, Housing Authorities, Senior Centers, and SHINE Counselors. The primary objective of this position is to identify prospective SCO-eligible members, explain the features and benefits of the plan in an assigned territory\/marketplace, and assist with enrollment into the plan. Successful candidates generate leads from a variety of sources including networking, account management, grassroots sources as well as from member referrals. <\/p> Job Description <\/b><\/p> Key Responsibilities\/Duties \u2013 what you will be doing (top five):<\/p> Qualifications \u2013 what you need to perform the job<\/p> Certification and Licensure<\/p> Education<\/p> Experience<\/p> Skill Requirements<\/p> Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):<\/p> Disclaimer<\/p> 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.<\/p> <\/p> <\/p> Compensation & Total Rewards Overview<\/b><\/p> 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\u2019s sole discretion, consistent with the law.<\/p> <\/p> Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:<\/p> Medical, dental and vision coverage<\/p><\/li> Retirement plans<\/p><\/li> Paid time off<\/p><\/li> Employer-paid life and disability insurance with additional buy-up coverage options<\/p><\/li> Tuition program<\/p><\/li> Well-being benefits<\/p><\/li> Full suite of benefits to support career development, individual & family health, and financial health<\/p><\/li><\/ul> For more details on our total rewards programs, visit https:\/\/www.point32health.org\/careers\/benefits\/<\/a><\/p> <\/p> We welcome all<\/b> <\/p> Scam Alert<\/b>: 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 TA_operations@point32health.org<\/a><\/p> <\/p>
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.<\/p>

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\u2019ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it\u2019s 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. <\/p>
<\/p>
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<\/a>.<\/p> <\/p> Job Summary<\/b><\/p>Independently conduct analysis and data development for a broad range of financial and actuarial functions regarding the Commercial lines of business with a focus on forecasting and budgeting. Analyses may include financial planning and forecasting, trend analysis, and product performance evaluation. This is an analytical and technical position in which the analyst must be able to perform independently and execute and\/or oversee all the analytical and technical tasks required to take a project from inception to conclusion. This role will work closely with one or more THP departments including Underwriting, Finance, Sales, and Network Contracting. <\/p> Job Description <\/b><\/p> Planning, Design, Project\/Process Management<\/b> EDUCATION: <\/b><\/p> <\/p> EXPERIENCE: <\/b><\/p> <\/p> SKILL REQUIREMENTS: <\/b><\/p> <\/p> WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: <\/b>(include special requirements, e.g., lifting, travel, overtime)<\/p> Fast paced office environment in which the individual must be able to work extended hours when necessary. <\/p> <\/p> <\/p> <\/p> Compensation & Total Rewards Overview<\/b><\/p> 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\u2019s sole discretion, consistent with the law.<\/p> <\/p> Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:<\/p> Medical, dental and vision coverage<\/p><\/li> Retirement plans<\/p><\/li> Paid time off<\/p><\/li> Employer-paid life and disability insurance with additional buy-up coverage options<\/p><\/li> Tuition program<\/p><\/li> Well-being benefits<\/p><\/li> Full suite of benefits to support career development, individual & family health, and financial health<\/p><\/li><\/ul> For more details on our total rewards programs, visit https:\/\/www.point32health.org\/careers\/benefits\/<\/a><\/p> <\/p> We welcome all<\/b> <\/p> Scam Alert<\/b>: 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 TA_operations@point32health.org<\/a><\/p> <\/p>
This role requires an understanding of the health insurance industry, strong interpersonal skills, and proficiency in relational databases, data warehouses, Excel, and statistical modeling.
\u2022 Performs analytic project work assigned by manager with minimal supervision.
\u2022 Develops analytic project plan to meet defined objectives.
\u2022 Facilitates planning and review sessions.
Technical Analysis<\/b>
\u2022 Uses THP data systems and query tools to complete work projects, developing new code and tools to meet objectives.
Analysis\/Interpretation<\/b>
\u2022 Examines and interprets results in the context of the specific business questions being addressed.
\u2022 Identifies new questions and\/or unforeseen data complexities arising from results and takes steps to address them
Checking\/Validation\/Peer Review<\/b>
\u2022 Develops criteria to validate results in light of prior expectations
\u2022 Investigates unusual results and offers explanations
\u2022 Assists colleagues and more junior staff with validation\/checking activities
Communication\/Presentation of Results<\/b>
\u2022 Packages results to demonstrate how the analysis meets project objectives<\/p>
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.<\/p>

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\u2019ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it\u2019s 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. <\/p>
<\/p>
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<\/a>.<\/p> <\/p> Job Summary<\/b><\/p>Independently conduct analysis and data development for a broad range of financial and actuarial functions regarding the Commercial lines of business with a focus on forecasting and budgeting. Analyses may include financial planning and forecasting, trend analysis, and product performance evaluation. This is an analytical and technical position in which the analyst must be able to perform independently and execute and\/or oversee all the analytical and technical tasks required to take a project from inception to conclusion. This role will work closely with one or more THP departments including Underwriting, Finance, Sales, and Network Contracting. <\/p> Job Description <\/b><\/p> Planning, Design, Project\/Process Management<\/b> EDUCATION: <\/b><\/p> <\/p> EXPERIENCE: <\/b><\/p> <\/p> SKILL REQUIREMENTS: <\/b><\/p> <\/p> WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: <\/b>(include special requirements, e.g., lifting, travel, overtime)<\/p> Fast paced office environment in which the individual must be able to work extended hours when necessary. <\/p> <\/p> <\/p> <\/p> Compensation & Total Rewards Overview<\/b><\/p> 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\u2019s sole discretion, consistent with the law.<\/p> <\/p> Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:<\/p> Medical, dental and vision coverage<\/p><\/li> Retirement plans<\/p><\/li> Paid time off<\/p><\/li> Employer-paid life and disability insurance with additional buy-up coverage options<\/p><\/li> Tuition program<\/p><\/li> Well-being benefits<\/p><\/li> Full suite of benefits to support career development, individual & family health, and financial health<\/p><\/li><\/ul> For more details on our total rewards programs, visit https:\/\/www.point32health.org\/careers\/benefits\/<\/a><\/p> <\/p> We welcome all<\/b> <\/p> Scam Alert<\/b>: 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 TA_operations@point32health.org<\/a><\/p> <\/p>
This role requires an understanding of the health insurance industry, strong interpersonal skills, and proficiency in relational databases, data warehouses, Excel, and statistical modeling.
\u2022 Performs analytic project work assigned by manager with minimal supervision.
\u2022 Develops analytic project plan to meet defined objectives.
\u2022 Facilitates planning and review sessions.
Technical Analysis<\/b>
\u2022 Uses THP data systems and query tools to complete work projects, developing new code and tools to meet objectives.
Analysis\/Interpretation<\/b>
\u2022 Examines and interprets results in the context of the specific business questions being addressed.
\u2022 Identifies new questions and\/or unforeseen data complexities arising from results and takes steps to address them
Checking\/Validation\/Peer Review<\/b>
\u2022 Develops criteria to validate results in light of prior expectations
\u2022 Investigates unusual results and offers explanations
\u2022 Assists colleagues and more junior staff with validation\/checking activities
Communication\/Presentation of Results<\/b>
\u2022 Packages results to demonstrate how the analysis meets project objectives<\/p>
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.<\/p>

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\u2019ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it\u2019s 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. <\/p>
<\/p>
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<\/a>.<\/p> <\/p> Job Summary<\/b><\/p>Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with the member and\/or the member\u2019s authorized representative and must demonstrate superior customer service and benefit interpretation skills in all interactions. This individual prepares cases for presentation, discussion, review, and final disposition at the Member Appeals Committee (MAC) and Member Appeals Reconsideration Committee (MARC) and participates in the Appeals Committee discussion when needed. Responsibilities include development and coordination of all written documentation and correspondence to the member outlining final disposition of the member\u2019s appeal or grievance providing further appeal options as appropriate. Analysts routinely interact with members, providers, and other internal and external constituents about highly escalated issues. <\/p> Job Description <\/b><\/p> <\/p> Qualifications<\/u><\/b> \u2013 what you need to perform the job<\/b><\/p> <\/p> Certification and Licensure<\/b><\/p> <\/p> Education<\/b><\/p> <\/p> Experience<\/b><\/p> <\/p> Skill Requirements<\/b><\/p> <\/p> <\/p> Working Conditions and Additional Requirements <\/b>(include special requirements, e.g., lifting, travel):<\/b><\/p> <\/p> Disclaimer<\/b><\/p> 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.<\/p> <\/p> <\/p> Compensation & Total Rewards Overview<\/b><\/p> 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\u2019s sole discretion, consistent with the law.<\/p> <\/p> Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:<\/p> Medical, dental and vision coverage<\/p><\/li> Retirement plans<\/p><\/li> Paid time off<\/p><\/li> Employer-paid life and disability insurance with additional buy-up coverage options<\/p><\/li> Tuition program<\/p><\/li> Well-being benefits<\/p><\/li> Full suite of benefits to support career development, individual & family health, and financial health<\/p><\/li><\/ul> For more details on our total rewards programs, visit https:\/\/www.point32health.org\/careers\/benefits\/<\/a><\/p> <\/p> We welcome all<\/b> <\/p> Scam Alert<\/b>: 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 TA_operations@point32health.org<\/a><\/p> <\/p>
Essential functions will occur simultaneously; therefore, the employee must be able to appropriately handle each of these functions, prioritize them, and seek assistance when necessary. The employee must have the ability to learn and apply Point32Health\u2019s policies and remain compliant with frequently changing State and Federal regulatory requirements and have the judgment to seek out guidance as needed. The Analyst is responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for all lines of business.
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.<\/p>

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\u2019ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it\u2019s 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. <\/p>
<\/p>
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<\/a>.<\/p> <\/p> Job Summary<\/b><\/p>Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with the member and\/or the member\u2019s authorized representative and must demonstrate superior customer service and benefit interpretation skills in all interactions. This individual prepares cases for presentation, discussion, review, and final disposition at the Member Appeals Committee (MAC) and Member Appeals Reconsideration Committee (MARC) and participates in the Appeals Committee discussion when needed. Responsibilities include development and coordination of all written documentation and correspondence to the member outlining final disposition of the member\u2019s appeal or grievance providing further appeal options as appropriate. Analysts routinely interact with members, providers, and other internal and external constituents about highly escalated issues. <\/p> Job Description <\/b><\/p> <\/p> Qualifications<\/u><\/b> \u2013 what you need to perform the job<\/b><\/p> <\/p> Certification and Licensure<\/b><\/p> <\/p> Education<\/b><\/p> <\/p> Experience<\/b><\/p> <\/p> Skill Requirements<\/b><\/p> <\/p> <\/p> Working Conditions and Additional Requirements <\/b>(include special requirements, e.g., lifting, travel):<\/b><\/p> <\/p> Disclaimer<\/b><\/p> 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.<\/p> <\/p> <\/p> Compensation & Total Rewards Overview<\/b><\/p> 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\u2019s sole discretion, consistent with the law.<\/p> <\/p> Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:<\/p> Medical, dental and vision coverage<\/p><\/li> Retirement plans<\/p><\/li> Paid time off<\/p><\/li> Employer-paid life and disability insurance with additional buy-up coverage options<\/p><\/li> Tuition program<\/p><\/li> Well-being benefits<\/p><\/li> Full suite of benefits to support career development, individual & family health, and financial health<\/p><\/li><\/ul> For more details on our total rewards programs, visit https:\/\/www.point32health.org\/careers\/benefits\/<\/a><\/p> <\/p> We welcome all<\/b> <\/p> Scam Alert<\/b>: 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 TA_operations@point32health.org<\/a><\/p> <\/p>
Essential functions will occur simultaneously; therefore, the employee must be able to appropriately handle each of these functions, prioritize them, and seek assistance when necessary. The employee must have the ability to learn and apply Point32Health\u2019s policies and remain compliant with frequently changing State and Federal regulatory requirements and have the judgment to seek out guidance as needed. The Analyst is responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for all lines of business.
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.<\/p>

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\u2019ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it\u2019s 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. <\/p>
<\/p>
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<\/a>.<\/p> <\/p> Job Summary<\/b><\/p>Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with the member and\/or the member\u2019s authorized representative and must demonstrate superior customer service and benefit interpretation skills in all interactions. This individual prepares cases for presentation, discussion, review, and final disposition at the Member Appeals Committee (MAC) and Member Appeals Reconsideration Committee (MARC) and participates in the Appeals Committee discussion when needed. Responsibilities include development and coordination of all written documentation and correspondence to the member outlining final disposition of the member\u2019s appeal or grievance providing further appeal options as appropriate. Analysts routinely interact with members, providers, and other internal and external constituents about highly escalated issues. <\/p> Job Description <\/b><\/p> <\/p> Qualifications<\/u><\/b> \u2013 what you need to perform the job<\/b><\/p> <\/p> Certification and Licensure<\/b><\/p> <\/p> Education<\/b><\/p> <\/p> Experience<\/b><\/p> <\/p> Skill Requirements<\/b><\/p> <\/p> <\/p> Working Conditions and Additional Requirements <\/b>(include special requirements, e.g., lifting, travel):<\/b><\/p> <\/p> Disclaimer<\/b><\/p> 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.<\/p> <\/p> <\/p> Compensation & Total Rewards Overview<\/b><\/p> 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\u2019s sole discretion, consistent with the law.<\/p> <\/p> Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:<\/p> Medical, dental and vision coverage<\/p><\/li> Retirement plans<\/p><\/li> Paid time off<\/p><\/li> Employer-paid life and disability insurance with additional buy-up coverage options<\/p><\/li> Tuition program<\/p><\/li> Well-being benefits<\/p><\/li> Full suite of benefits to support career development, individual & family health, and financial health<\/p><\/li><\/ul> For more details on our total rewards programs, visit https:\/\/www.point32health.org\/careers\/benefits\/<\/a><\/p> <\/p> We welcome all<\/b> <\/p> Scam Alert<\/b>: 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 TA_operations@point32health.org<\/a><\/p> <\/p>
Essential functions will occur simultaneously; therefore, the employee must be able to appropriately handle each of these functions, prioritize them, and seek assistance when necessary. The employee must have the ability to learn and apply Point32Health\u2019s policies and remain compliant with frequently changing State and Federal regulatory requirements and have the judgment to seek out guidance as needed. The Analyst is responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for all lines of business.
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.<\/p>

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\u2019ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it\u2019s 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. <\/p>
<\/p>
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<\/a>.<\/p> <\/p> Job Summary<\/b><\/p>Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with the member and\/or the member\u2019s authorized representative and must demonstrate superior customer service and benefit interpretation skills in all interactions. This individual prepares cases for presentation, discussion, review, and final disposition at the Member Appeals Committee (MAC) and Member Appeals Reconsideration Committee (MARC) and participates in the Appeals Committee discussion when needed. Responsibilities include development and coordination of all written documentation and correspondence to the member outlining final disposition of the member\u2019s appeal or grievance providing further appeal options as appropriate. Analysts routinely interact with members, providers, and other internal and external constituents about highly escalated issues. <\/p> Job Description <\/b><\/p> <\/p> Qualifications<\/u><\/b> \u2013 what you need to perform the job<\/b><\/p> <\/p> Certification and Licensure<\/b><\/p> <\/p> Education<\/b><\/p> <\/p> Experience<\/b><\/p> <\/p> Skill Requirements<\/b><\/p> <\/p> <\/p> Working Conditions and Additional Requirements <\/b>(include special requirements, e.g., lifting, travel):<\/b><\/p> <\/p> Disclaimer<\/b><\/p> 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.<\/p> <\/p> <\/p> Compensation & Total Rewards Overview<\/b><\/p> 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\u2019s sole discretion, consistent with the law.<\/p> <\/p> Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:<\/p> Medical, dental and vision coverage<\/p><\/li> Retirement plans<\/p><\/li> Paid time off<\/p><\/li> Employer-paid life and disability insurance with additional buy-up coverage options<\/p><\/li> Tuition program<\/p><\/li> Well-being benefits<\/p><\/li> Full suite of benefits to support career development, individual & family health, and financial health<\/p><\/li><\/ul> For more details on our total rewards programs, visit https:\/\/www.point32health.org\/careers\/benefits\/<\/a><\/p> <\/p> We welcome all<\/b> <\/p> Scam Alert<\/b>: 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 TA_operations@point32health.org<\/a><\/p> <\/p>
Essential functions will occur simultaneously; therefore, the employee must be able to appropriately handle each of these functions, prioritize them, and seek assistance when necessary. The employee must have the ability to learn and apply Point32Health\u2019s policies and remain compliant with frequently changing State and Federal regulatory requirements and have the judgment to seek out guidance as needed. The Analyst is responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for all lines of business.
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.<\/p>

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\u2019ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it\u2019s 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. <\/p>
<\/p>
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<\/a>.<\/p> <\/p> Job Summary<\/b><\/p>Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with the member and\/or the member\u2019s authorized representative and must demonstrate superior customer service and benefit interpretation skills in all interactions. This individual prepares cases for presentation, discussion, review, and final disposition at the Member Appeals Committee (MAC) and Member Appeals Reconsideration Committee (MARC) and participates in the Appeals Committee discussion when needed. Responsibilities include development and coordination of all written documentation and correspondence to the member outlining final disposition of the member\u2019s appeal or grievance providing further appeal options as appropriate. Analysts routinely interact with members, providers, and other internal and external constituents about highly escalated issues. <\/p> Job Description <\/b><\/p> <\/p> Qualifications<\/u><\/b> \u2013 what you need to perform the job<\/b><\/p> <\/p> Certification and Licensure<\/b><\/p> <\/p> Education<\/b><\/p> <\/p> Experience<\/b><\/p> <\/p> Skill Requirements<\/b><\/p> <\/p> <\/p> Working Conditions and Additional Requirements <\/b>(include special requirements, e.g., lifting, travel):<\/b><\/p> <\/p> Disclaimer<\/b><\/p> 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.<\/p> <\/p> <\/p> Compensation & Total Rewards Overview<\/b><\/p> 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\u2019s sole discretion, consistent with the law.<\/p> <\/p> Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:<\/p> Medical, dental and vision coverage<\/p><\/li> Retirement plans<\/p><\/li> Paid time off<\/p><\/li> Employer-paid life and disability insurance with additional buy-up coverage options<\/p><\/li> Tuition program<\/p><\/li> Well-being benefits<\/p><\/li> Full suite of benefits to support career development, individual & family health, and financial health<\/p><\/li><\/ul> For more details on our total rewards programs, visit https:\/\/www.point32health.org\/careers\/benefits\/<\/a><\/p> <\/p> We welcome all<\/b> <\/p> Scam Alert<\/b>: 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 TA_operations@point32health.org<\/a><\/p> <\/p>
Essential functions will occur simultaneously; therefore, the employee must be able to appropriately handle each of these functions, prioritize them, and seek assistance when necessary. The employee must have the ability to learn and apply Point32Health\u2019s policies and remain compliant with frequently changing State and Federal regulatory requirements and have the judgment to seek out guidance as needed. The Analyst is responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for all lines of business.
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.<\/p>

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\u2019ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it\u2019s 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. <\/p>
<\/p>
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<\/a>.<\/p> <\/p> Job Summary<\/b><\/p>Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with the member and\/or the member\u2019s authorized representative and must demonstrate superior customer service and benefit interpretation skills in all interactions. This individual prepares cases for presentation, discussion, review, and final disposition at the Member Appeals Committee (MAC) and Member Appeals Reconsideration Committee (MARC) and participates in the Appeals Committee discussion when needed. Responsibilities include development and coordination of all written documentation and correspondence to the member outlining final disposition of the member\u2019s appeal or grievance providing further appeal options as appropriate. Analysts routinely interact with members, providers, and other internal and external constituents about highly escalated issues. <\/p> Job Description <\/b><\/p> <\/p> Qualifications<\/u><\/b> \u2013 what you need to perform the job<\/b><\/p> <\/p> Certification and Licensure<\/b><\/p> <\/p> Education<\/b><\/p> <\/p> Experience<\/b><\/p> <\/p> Skill Requirements<\/b><\/p> <\/p> <\/p> Working Conditions and Additional Requirements <\/b>(include special requirements, e.g., lifting, travel):<\/b><\/p> <\/p> Disclaimer<\/b><\/p> 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.<\/p> <\/p> <\/p> Compensation & Total Rewards Overview<\/b><\/p> 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\u2019s sole discretion, consistent with the law.<\/p> <\/p> Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:<\/p> Medical, dental and vision coverage<\/p><\/li> Retirement plans<\/p><\/li> Paid time off<\/p><\/li> Employer-paid life and disability insurance with additional buy-up coverage options<\/p><\/li> Tuition program<\/p><\/li> Well-being benefits<\/p><\/li> Full suite of benefits to support career development, individual & family health, and financial health<\/p><\/li><\/ul> For more details on our total rewards programs, visit https:\/\/www.point32health.org\/careers\/benefits\/<\/a><\/p> <\/p> We welcome all<\/b> <\/p> Scam Alert<\/b>: 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 TA_operations@point32health.org<\/a><\/p> <\/p>
Essential functions will occur simultaneously; therefore, the employee must be able to appropriately handle each of these functions, prioritize them, and seek assistance when necessary. The employee must have the ability to learn and apply Point32Health\u2019s policies and remain compliant with frequently changing State and Federal regulatory requirements and have the judgment to seek out guidance as needed. The Analyst is responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for all lines of business.
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.<\/p>

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\u2019ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it\u2019s 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. <\/p>
<\/p>
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<\/a>.<\/p> <\/p> Job Summary<\/b><\/p>Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with the member and\/or the member\u2019s authorized representative and must demonstrate superior customer service and benefit interpretation skills in all interactions. This individual prepares cases for presentation, discussion, review, and final disposition at the Member Appeals Committee (MAC) and Member Appeals Reconsideration Committee (MARC) and participates in the Appeals Committee discussion when needed. Responsibilities include development and coordination of all written documentation and correspondence to the member outlining final disposition of the member\u2019s appeal or grievance providing further appeal options as appropriate. Analysts routinely interact with members, providers, and other internal and external constituents about highly escalated issues. <\/p> Job Description <\/b><\/p> <\/p> Qualifications<\/u><\/b> \u2013 what you need to perform the job<\/b><\/p> <\/p> Certification and Licensure<\/b><\/p> <\/p> Education<\/b><\/p> <\/p> Experience<\/b><\/p> <\/p> Skill Requirements<\/b><\/p> <\/p> <\/p> Working Conditions and Additional Requirements <\/b>(include special requirements, e.g., lifting, travel):<\/b><\/p> <\/p> Disclaimer<\/b><\/p> 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.<\/p> <\/p> <\/p> Compensation & Total Rewards Overview<\/b><\/p> 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\u2019s sole discretion, consistent with the law.<\/p> <\/p> Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:<\/p> Medical, dental and vision coverage<\/p><\/li> Retirement plans<\/p><\/li> Paid time off<\/p><\/li> Employer-paid life and disability insurance with additional buy-up coverage options<\/p><\/li> Tuition program<\/p><\/li> Well-being benefits<\/p><\/li> Full suite of benefits to support career development, individual & family health, and financial health<\/p><\/li><\/ul> For more details on our total rewards programs, visit https:\/\/www.point32health.org\/careers\/benefits\/<\/a><\/p> <\/p> We welcome all<\/b> <\/p> Scam Alert<\/b>: 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 TA_operations@point32health.org<\/a><\/p> <\/p>
Essential functions will occur simultaneously; therefore, the employee must be able to appropriately handle each of these functions, prioritize them, and seek assistance when necessary. The employee must have the ability to learn and apply Point32Health\u2019s policies and remain compliant with frequently changing State and Federal regulatory requirements and have the judgment to seek out guidance as needed. The Analyst is responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for all lines of business.
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.<\/p>

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\u2019ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it\u2019s 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. <\/p>
<\/p>
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<\/a>.<\/p> <\/p> Job Summary<\/b><\/p>Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with the member and\/or the member\u2019s authorized representative and must demonstrate superior customer service and benefit interpretation skills in all interactions. This individual prepares cases for presentation, discussion, review, and final disposition at the Member Appeals Committee (MAC) and Member Appeals Reconsideration Committee (MARC) and participates in the Appeals Committee discussion when needed. Responsibilities include development and coordination of all written documentation and correspondence to the member outlining final disposition of the member\u2019s appeal or grievance providing further appeal options as appropriate. Analysts routinely interact with members, providers, and other internal and external constituents about highly escalated issues. <\/p> Job Description <\/b><\/p> <\/p> Qualifications<\/u><\/b> \u2013 what you need to perform the job<\/b><\/p> <\/p> Certification and Licensure<\/b><\/p> <\/p> Education<\/b><\/p> <\/p> Experience<\/b><\/p> <\/p> Skill Requirements<\/b><\/p> <\/p> <\/p> Working Conditions and Additional Requirements <\/b>(include special requirements, e.g., lifting, travel):<\/b><\/p> <\/p> Disclaimer<\/b><\/p> 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.<\/p> <\/p> <\/p> Compensation & Total Rewards Overview<\/b><\/p> 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\u2019s sole discretion, consistent with the law.<\/p> <\/p> Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:<\/p> Medical, dental and vision coverage<\/p><\/li> Retirement plans<\/p><\/li> Paid time off<\/p><\/li> Employer-paid life and disability insurance with additional buy-up coverage options<\/p><\/li> Tuition program<\/p><\/li> Well-being benefits<\/p><\/li> Full suite of benefits to support career development, individual & family health, and financial health<\/p><\/li><\/ul> For more details on our total rewards programs, visit https:\/\/www.point32health.org\/careers\/benefits\/<\/a><\/p> <\/p> We welcome all<\/b> <\/p> Scam Alert<\/b>: 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 TA_operations@point32health.org<\/a><\/p> <\/p>
Essential functions will occur simultaneously; therefore, the employee must be able to appropriately handle each of these functions, prioritize them, and seek assistance when necessary. The employee must have the ability to learn and apply Point32Health\u2019s policies and remain compliant with frequently changing State and Federal regulatory requirements and have the judgment to seek out guidance as needed. The Analyst is responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for all lines of business.
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.<\/p>

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\u2019ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it\u2019s 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. <\/p>
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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<\/a>.<\/p> <\/p> Job Summary<\/b><\/p>Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with the member and\/or the member\u2019s authorized representative and must demonstrate superior customer service and benefit interpretation skills in all interactions. This individual prepares cases for presentation, discussion, review, and final disposition at the Member Appeals Committee (MAC) and Member Appeals Reconsideration Committee (MARC) and participates in the Appeals Committee discussion when needed. Responsibilities include development and coordination of all written documentation and correspondence to the member outlining final disposition of the member\u2019s appeal or grievance providing further appeal options as appropriate. Analysts routinely interact with members, providers, and other internal and external constituents about highly escalated issues. <\/p> Job Description <\/b><\/p> <\/p> Qualifications<\/u><\/b> \u2013 what you need to perform the job<\/b><\/p> <\/p> Certification and Licensure<\/b><\/p> <\/p> Education<\/b><\/p> <\/p> Experience<\/b><\/p> <\/p> Skill Requirements<\/b><\/p> <\/p> <\/p> Working Conditions and Additional Requirements <\/b>(include special requirements, e.g., lifting, travel):<\/b><\/p> <\/p> Disclaimer<\/b><\/p> 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.<\/p> <\/p> <\/p> Compensation & Total Rewards Overview<\/b><\/p> 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\u2019s sole discretion, consistent with the law.<\/p> <\/p> Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:<\/p> Medical, dental and vision coverage<\/p><\/li> Retirement plans<\/p><\/li> Paid time off<\/p><\/li> Employer-paid life and disability insurance with additional buy-up coverage options<\/p><\/li> Tuition program<\/p><\/li> Well-being benefits<\/p><\/li> Full suite of benefits to support career development, individual & family health, and financial health<\/p><\/li><\/ul> For more details on our total rewards programs, visit https:\/\/www.point32health.org\/careers\/benefits\/<\/a><\/p> <\/p> We welcome all<\/b> <\/p> Scam Alert<\/b>: 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 TA_operations@point32health.org<\/a><\/p> <\/p>
Essential functions will occur simultaneously; therefore, the employee must be able to appropriately handle each of these functions, prioritize them, and seek assistance when necessary. The employee must have the ability to learn and apply Point32Health\u2019s policies and remain compliant with frequently changing State and Federal regulatory requirements and have the judgment to seek out guidance as needed. The Analyst is responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for all lines of business.
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.<\/p>

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\u2019ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it\u2019s 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. <\/p>
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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<\/a>.<\/p> <\/p> Job Summary<\/b><\/p>Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with the member and\/or the member\u2019s authorized representative and must demonstrate superior customer service and benefit interpretation skills in all interactions. This individual prepares cases for presentation, discussion, review, and final disposition at the Member Appeals Committee (MAC) and Member Appeals Reconsideration Committee (MARC) and participates in the Appeals Committee discussion when needed. Responsibilities include development and coordination of all written documentation and correspondence to the member outlining final disposition of the member\u2019s appeal or grievance providing further appeal options as appropriate. Analysts routinely interact with members, providers, and other internal and external constituents about highly escalated issues. <\/p> Job Description <\/b><\/p> EDUCATION, CERTIFICATION AND LICENSURE: <\/b><\/p> <\/p> EXPERIENCE <\/b>(minimum years required):<\/b><\/p> <\/p> SKILL REQUIREMENTS: <\/b><\/p> <\/p> WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS <\/b>(include special requirements, e.g., lifting, travel):<\/b><\/p> 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.<\/p> <\/p> <\/p> Compensation & Total Rewards Overview<\/b><\/p> 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\u2019s sole discretion, consistent with the law.<\/p> <\/p> Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:<\/p> Medical, dental and vision coverage<\/p><\/li> Retirement plans<\/p><\/li> Paid time off<\/p><\/li> Employer-paid life and disability insurance with additional buy-up coverage options<\/p><\/li> Tuition program<\/p><\/li> Well-being benefits<\/p><\/li> Full suite of benefits to support career development, individual & family health, and financial health<\/p><\/li><\/ul> For more details on our total rewards programs, visit https:\/\/www.point32health.org\/careers\/benefits\/<\/a><\/p> <\/p> We welcome all<\/b> <\/p> Scam Alert<\/b>: 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 TA_operations@point32health.org<\/a><\/p> <\/p>
Essential functions will occur simultaneously; therefore, the employee must be able to appropriately handle each of these functions, prioritize them, and seek assistance when necessary. The employee must have the ability to learn and apply Point32Health\u2019s policies and remain compliant with frequently changing State and Federal regulatory requirements and have the judgment to seek out guidance as needed. The Analyst is responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for all lines of business.
Disclaimer<\/b><\/p>
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.<\/p>