20 Best jobs in Worcester, MA (Hiring Now!)

Member Appeals and Grievance Intake Admin
Fallon Health —Worcester, MA
Experience: 2 years college education or knowledge of healthcare field equal to 2 years college preparation or 2 years or more administrative experience.
4d
Diesel Mechanic-3 years truck diesel mechanicexperience required
Nashoba Valley Express —Ayer, MA
Drivers license is highly required. Knowledge of a vehicle, its electrical system and the mechanisms of a diesel engine.
From $30 an hour
Quick Apply
Class A Heavy Wrecker Operator
Hiway Recovery Inc —Upton, MA
Hiway Recovery is seeking qualified individuals to run and operate a heavy duty wrecker/ tow truck. Looking for experienced operators but willing to train.
From $23 an hour
Quick Apply
Per Diem Field Nurse Supervisor ~ Worcester
Premier Home Healthcare Services Inc —Worcester, MA
The employee must have a valid driver’s license issued by the state in which they work and a satisfactory driving record. Home Care: 1 year (Required).
Estimated: $94.4K - $120K a year
Quick Apply
Cashier
TESCO Staffing —Worcester, MA
Greet customers entering and leaving the business *Maintain a clean and tidy work area *Accurately process all cash and credit payments *Provide exceptional…
$18.50 - $19.00 an hour
Quick Apply
2d
Delivery Driver - Amazon Associate
Amazon DSP —Worcester, MA
· Must hold a non-provisional, unrestricted driver’s license*. Follow all local & state laws, road/driving regulations, and Company policies · Provide excellent…
$20 an hour
Quick Apply
14d
Master Tax Advisor, Enrolled Agent
Accounting and Tax Associates inc —Worcester, MA
At least 4 years active Tax Preparation experience. Organize work effectively to meet deadlines and take ownership of projects and actions.
$80,000 - $90,000 a year
Quick Apply
Board Certified Behavior Analyst (BCBA) - Open House
ABA Centers of America —Worcester, MA
Conduct assessments related to the need for behavioral intervention (e.g., preference assessment, functional assessment, staff performance assessment, etc.).
$85,000 - $100,000 a year
Quick Apply
Board Certified Behavior Analyst
Autism Therapeutic Services LLC —Worcester, MA
Must have a Master's degree from an accredited university or college in Psychology or related field. Dependability: Follows instructions; responds to management…
$85,000 - $95,000 a year
Quick Apply
Mortgage Loan Originator
Webster Five —Auburn, MA
Customarily and regularly makes business development and sales calls on mortgage loan prospects and customers at their places of business and solicits mortgage…
Estimated: $62.3K - $78.8K a year
Quick Apply
Cannabis Packaging Associate
Temescal Wellness —Worcester, MA
They are also responsible for maintaining the high standard of cleanliness that our state-of-the-art cannabis production facility requires.
$17 - $18 an hour
Quick Apply
10d
Registered Nurse
McAuley Nazareth Inc. —Leicester, MA
Must have a valid driver’s license. Maintain active certification in MAP, First Aid, CPR, CPI Non-violent Crisis Intervention and attend all other required…
$58,000 - $80,000 a year
Quick Apply
Receptionist/Administrative Assistant
Boyle | Shaughnessy Law —Worcester, MA
Reception duties include: Answering mutli-line phones, greeting guests, maintaining conference rooms, etc. This position requires a high level of attention to…
From $25 an hour
Quick Apply
6d
ARDMS Breast Sonographer
HerScan —Worcester, MA
Active certification by American Registry of Diagnostic Medical Sonographers (ARDMS) in Breast or by the American Registry of Radiologic Technology (ARRT, BS)…
$35 - $50 an hour
Quick Apply
Customer Service Representative/Call Center Agent
Onsite National —Auburn, MA
National Truck E.R.S. also handles fleet and project management when called upon by our client's. CALL CENTER-CUSTOMER SERVICE REPS. Shifts:1st 2nd and 3rd.
$18 - $24 an hour
Quick Apply
Receptionist
Comm Against Discrimination —Worcester, MA
The Receptionist will maintain files and records; answer telephones; interact with the public on the telephone and in-person; prepare and mail outgoing…
$52,939.90 - $74,637.42 a year
4d
Floral Associate
Perro's Flowers —Worcester, MA
Present and answer questions about our products and services, making appropriate recommendations to customers. Computer proficiency for sales and order entry.
From $20 an hour
Quick Apply
Stocking Associate (7a-4p)
Walmart —North Oxford, MA
Planning and Improvement:Plan for and Improve Work : Accepts responsibility and meets expectations for own work. Reports ethical and compliance issues promptly.
From $16 an hour
Quick Apply
Patient Experience Coordinator
Skin Dermatology —Shrewsbury, MA
We do this through our attentive and knowledgeable team who formulates individualized treatment plans utilizing information technology advancements in our state…
$17 - $22 an hour
General Dentist
Milford Family Dental —Milford, MA
Must maintain minimum CE credit hours, CPR and state dental license. Graduate of accredited or certified dental school program.
From $750 a day
Quick Apply

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Member Appeals and Grievance Intake Admin

Fallon Health - Worcester, MA

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Job Details

Full-time 4 days ago

Qualifications

Microsoft Excel
Bachelor of Science
Microsoft Office
Administrative experience
Bachelor's degree
NCQA standards
2 years
Bachelor of Arts

Full Job Description

Overview:

The Member Appeals and Grievances Intake Administrator is working M - F 8 am to 5 pm in the office 5 days/week. We are looking for someone that is organized, detail oriented and enjoys data entry. This role is working with a supportive and fun team with growth potential.

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:

Fallon Health (FH) Appeals and Grievance process is an essential function to FH’s compliance with CMS regulations, NCQA standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH Appeals and Grievance process as outlined in the FH Member Handbook/Evidence of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals & Grievances Department. This position will also provide administrative support to the department.

Responsibilities:

Primary Job Responsibilities

Administer 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 initial investigator and contact person for member grievances and appeals, which includes, sending the appropriate acknowledgement of the grievance/appeal, educating the member and/or member representative about the grievance/appeal, gathering all pertinent and relevant information from the member regarding the grievance/appeal.
Print, mail, and triage letters at the FH corporate office located at 10 Chestnut Street, Worcester, MA.
Identifying the need for Personal Representative Authorization form, Medical Record Release Authorization form, or Provider Payment Waiver form and requests such documentation as necessary.
Assigning case files to the department staff for case management.
Managing incoming faxes and member specific data, routing to the appropriate staff member.
Producing, maintaining, and distributing reports/calendars utilized by the team to assist in workload planning.
Processes department incoming/outgoing mail per established workflows in a timely and accurate manner.
Providing administrative/clerical support to the department which may include acquisition of medical records from providers.
Retrieving messages from email and voice mailbox, routing to the appropriate staff member.
Photocopy and compilation of appeal case file when necessary.
Completion of request for additional information from external review agency.
Responsible for additional clerical/administrative responsibilities at the discretion of the Director or Manager.
Providing administrative assistance in support of the Board of Hearings (BOH) process, including preparation of hearing packets, reviewing of materials, as well as tracking and monitoring hearing decisions.
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: College Degree (B.S. or B.A.) or equivalent

License: Reliable transportation required

Experience: 2 years college education or knowledge of healthcare field equal to 2 years college preparation or 2 years or more administrative experience

Resources used in performing role:

QNXT
Microsoft Office Products
Trucare
Ring Central
Excel

COVID-19 Vaccination:

With the end of the Global Coronavirus COVID-19 Pandemic, Fallon Health no longer requires all employees to be vaccinated against COVID-19 except for employees who are in jobs that under state and federal laws, regulations and policies are required to be vaccinated and/or they are in Member/participant facing positions.

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

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jobs in Worcester, MA

Member Appeals and Grievance Intake Admin

Diesel Mechanic-3 years truck diesel mechanicexperience required

Class A Heavy Wrecker Operator

Per Diem Field Nurse Supervisor ~ Worcester

Cashier

Delivery Driver - Amazon Associate

Master Tax Advisor, Enrolled Agent

Board Certified Behavior Analyst (BCBA) - Open House

Board Certified Behavior Analyst

Mortgage Loan Originator

Cannabis Packaging Associate

Registered Nurse

Receptionist/Administrative Assistant

ARDMS Breast Sonographer

Customer Service Representative/Call Center Agent

Receptionist

Floral Associate

Stocking Associate (7a-4p)

Patient Experience Coordinator

General Dentist

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