Team Lead, Appeals and Grievances, Non Clinical Specialist

The Appeals & Grievances (A&G) team manages Healthfirst member complaints, grievances, and appeals. A&G works in collaboration with divisions within and outside the organization to resolve issues in a timely and compliant manner. For those assigned to non-clinical appeals, this includes reviewing the initial claim denial for accuracy, requesting additional information that may influence the appeal’s outcome, and working to substantiate your decision based on applicable policies and/ or regulations. For those assisting with member complains requires our team members to exercise their critical thinking, retrace a member’s journey, coordinate with internal and external parties in the goal of making our member whole, and improving their circumstances.…