Top 850 member services representative Jobs in worcester ma

Member Appeal & Grievance Coordinator - Flex schedule after 30 days
Fallon Health —Worcester, MA
- $60,000 - $65,500 a year
- Weekends as needed
- Bachelor of Science
- Research
- Mid-level
5d
Entry Level Marketing Representative
PrimePoint Consulting —Shrewsbury, MA
- $50,000 - $60,000 a year
- Full-time
- Background check
- No experience needed
- Residential
- Employee discount
Quick Apply
7d
CSR Call Center Bilingual (Portuguese) - Remote after Training
E-ZPass MA/TransCore —Auburn, MA
- $16.50 an hour
- Temporary
- Background check
- Pass drug screening
- English
Quick Apply
Maintenance Coordinator
Penske —Auburn, MA
- $19.52 - $24.38 an hour
- Microsoft Excel
- Microsoft Outlook
- Pass drug screening
5d
Call Center Service Reps – Hybrid/Remote! Training! Benefits! Career Path! $20.50/hr
Fallon Health —Worcester, MA
- $20.50 an hour
- Call employer
- Hybrid work
- Microsoft Word
- High school diploma or GED
- Bachelor's degree
- Health insurance
- Paid time off
7d
Registration Representative (Nights)
UMass Memorial Health Care —Worcester, MA
- $19.74 - $26.96 an hour
- 8 hour shift
- Surgery
- Computer literacy
- Writing skills
2d
Travel Respiratory Therapist (RRT)
Fusion Medical Staffing —Worcester, MA
- $2,159 - $2,482 a week
- PALS Certification
- Computer literacy
- BLS Certification
- Disability insurance
- Health insurance
Travel CT Technologist
Fusion Medical Staffing —Worcester, MA
- $2,160 - $2,482 a week
- Anatomy knowledge
- Hospital
- Computer literacy
- Disability insurance
- Health insurance
3d
Maintenance Technician III
Way Finders —Charlton, MA
- $24.00 - $27.25 an hour
- Full-time
- Spanish
- Clean driving record
- Computer literacy
- 403(b) matching
- Commuter assistance
13d
Travel Respiratory Therapist (RRT)
Fusion Medical Staffing —Worcester, MA
- $2,159 - $2,482 a week
- PALS Certification
- Computer literacy
- BLS Certification
- Disability insurance
- Health insurance
AWS Adjunct Instructor
California Institute of Applied Technology —Massachusetts
- $40 - $48 an hour
- Part-time
- Remote
- Microsoft Excel
- Computer literacy
- Mid-level
- Work from home
- Flexible schedule
Employee Benefits Account Manager
Cooney Health, Inc. —Framingham, MA
- $75,000 - $85,000 a year
- Full-time
- English
- Mid-level
- Office
- Health insurance
- Dental insurance
Quick Apply
Financial Advisor (Flexible Hybrid Work Environment)
New York Life Insurance Company/NYLIFE Securities, LLC. —Westborough, MA
- Up to $300,000 a year
- Full-time
- Hybrid work
- Hospitality
- English
- US work authorization
- Health insurance
- Dental insurance
Quick Apply
Operations Supervisor
Northeast Vehicle Services —Spencer, MA
- $25.00 - $32.50 an hour
- Extended hours
- Background check
- Management
- Heavy lifting
- Health insurance
- Dental insurance
Quick Apply
Bilingual Wireless Retail Sales Representative | Alliance Mobile - AT&T Authorized Retailer
Alliance Mobile Inc —Framingham, MA
- $17 - $30 an hour
- Weekends as needed
- High school
- English
- High school diploma or GED
- Paid training
- Paid holidays
Quick Apply
Athletically Minded Sales Representative
DaBella —Westborough, MA
- $70,000 - $125,000 a year
- Full-time
- Spanish
- Driver's License
- Travel
- Paid training
- Mileage reimbursement
Quick Apply
6d
Weekend Home Health Physical Therapist
BAYADA Home Health Care —Marlborough, MA
- $64 - $72 per point
- Part-time
- Physical & Rehabilitation Medicine
- Mid-level
- Home Health
- Paid holidays
- Health insurance
Quick Apply
Insurance Agency Client Service Representative
Parker Insurance & Financial Services —Whitinsville, MA
- $50,000 - $65,000 a year
- Full-time
- Microsoft Word
- CRM software
- Background check
- Paid time off
Quick Apply
Weekend Home Health Physical Therapist
BAYADA Home Health Care —Milford, MA
- $64 - $72 per point
- Part-time
- Physical & Rehabilitation Medicine
- Mid-level
- Home Health
- Paid holidays
- Health insurance
Quick Apply
Customer Service Account Specialist - Acton
Payright Payroll Services Inc. —Acton, MA
- $42,000 - $55,000 a year
- Extended hours
- Mid-level
- Office
- High school diploma or GED
- Disability insurance
- Health insurance
Quick Apply

I want to receive the latest job alert for member services representative in worcester ma

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

member services representative jobs near worcester ma

Registration jobs in Worcester, MA

Adjunct Instructor jobs in Massachusetts

Ct Technologist jobs in Worcester, MA

Respiratory Therapist jobs in Worcester, MA

Sales Representative jobs in Westborough, MA

Physical Therapist jobs in Marlborough, MA

Call Center Representative jobs in Worcester, MA

Physical Therapist jobs in Milford, MA

Insurance Agent jobs in Westborough, MA

Scheduling Coordinator jobs in Worcester, MA

Patient Registration jobs in Modesto, Ca

Patient Registration Summa jobs in Akron, Oh

Registration Remote jobs in Florida

Patient Registration jobs in Hayward, Ca

Patient Registration jobs in Knoxville, Tn

Patient Registration jobs in Arlington, Tx

Patient Registration jobs in San Antonio, Tx

Adjunct Faculty jobs in Portland, Or

Instructor Cosmetology jobs in Dallas, Tx

Adjunct Instructor jobs in Waterloo, Ia

Member Appeal & Grievance Coordinator - Flex schedule after 30 days

Fallon Health -
Worcester, MA

Apply Now

Job Details

Full-time
$60,000 - $65,500 a year
5 days ago

Qualifications

Research

Full Job Description

Overview:

About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief Summary of Purpose:

The Fallon Health (FH) Appeals and Grievance process is an essential function to FH compliance with CMS regulations, NCQA standards, other applicable regulatory requirements and member expectations. The FH Member Appeals & Grievances Coordinator serves to administer the FH Appeals and Grievance process as outlined in the Member Handbook/Evidence of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Coordinator serves as a liaison between FH members and FH with their complaints regarding denied claims, referrals, membership, and benefit issues as well as any grievances regarding quality of care or service. The Member Appeals & Grievances Coordinator is responsible for the presentation of the member appeal to the FH Medical Director, Center for Medicare/Medicaid Services, contracted reviewer, as well as the contracted external review agency in accordance with applicable laws, organization policies, and regulatory requirements. Thorough research, documentation, and corrective action planning must be established for each respective case and completed in accordance with existing regulations, policies and standards.

Responsibilities:

Primary Job Responsibilities:

Administrate FH Standard and Expedited Appeals Processes as outlined in Member Handbook/Evidence of Coverage for all products, and in compliance with applicable NCQA standards and other state or federal regulatory requirements. Strict adherence to department turn-around time standards established in accordance with regulatory standards is required.

Act as the primary investigator and contact person for member grievances and appeals, which includes, educating the member and/or member representative about the grievance/appeal, gathering all pertinent and relevant information from the member regarding the grievance/appeal, notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue.

Print and mail member letters at Fallon corporate HQ Worcester, MA several times per month and/or a needed, as designated through a rotational in-office calendar or at the direction of a supervisor or manager.

Answers telephone calls via ACD queue, as needed, within the FH’s standards for quality and service.

Ability to interpret and operationalize multiple products, the regulatory requirements and differences within each.

Ability to multitask and respond quickly and accurately to issues and concerns for members and internal departments.

Research, investigate, and document all action taken on behalf of the member to resolve the grievance/appeal.

On-call approximately one holiday (3-day) weekend per year and two (2-day) weekend every 5 weeks and as needed. Available by cell phone to accept new expedited appeal requests and, where necessary, to present to the FH office to process requests within applicable turn-around time standard.

Special projects as assigned by Management.

Conduct case management of legal/risk issues regarding member complaints, weighing interests of all customers, both internal and external.

Adhering to FH confidentiality policy; document, research and review member complaints, involving quality of care or quality of service with appropriate clinical and/or administrative staff.

Work with Team Leaders, Department Managers, Department Chairs and/or Medical Director to resolve member complaints; formulate improvement measures and responses to member; prepare written correspondence to members.

Forward all documentation involving member quality of care or quality of service complaints to FH administration and FH Quality Management Department.

Adhere to department standards for completion of member complaints.

Research and resolve system-wide issues, deficiencies, problems and formulate quality improvement measures. Ensure that all grievances/appeals are processed in adherence to state and federal regulations (i.e., CMS, MassHealth, OPP), contractual obligations, NCQA guidelines and FH policy.

Qualifications:

Education:

Bachelor of Science or Arts preferred but not required. Equivalent work experience is acceptable.

License/Certifications:

Reasonable transportation is required.

Experience:

1-3 years previous professional experience in related position (preferably in healthcare)

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $60,000 - $65,500 annually, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

#P01

Apply Now

Refine Your Search

member services representative jobs in worcester ma

Member Appeal & Grievance Coordinator - Flex schedule after 30 days

Entry Level Marketing Representative

CSR Call Center Bilingual (Portuguese) - Remote after Training

Maintenance Coordinator

Call Center Service Reps – Hybrid/Remote! Training! Benefits! Career Path! $20.50/hr

Registration Representative (Nights)

Travel Respiratory Therapist (RRT)

Travel CT Technologist

Maintenance Technician III

Travel Respiratory Therapist (RRT)

AWS Adjunct Instructor

Employee Benefits Account Manager

Financial Advisor (Flexible Hybrid Work Environment)

Operations Supervisor

Bilingual Wireless Retail Sales Representative | Alliance Mobile - AT&T Authorized Retailer

Athletically Minded Sales Representative

Weekend Home Health Physical Therapist

Insurance Agency Client Service Representative

Weekend Home Health Physical Therapist

Customer Service Account Specialist - Acton

I want to receive the latest job alert for member services representative in worcester ma

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected