Martin's Point Health Care Benefits Overview

Processes, investigates, and resolves member grievances for health plans while meeting CMS, NCQA, TRICARE, and other regulatory requirements. Duties include triaging cases, reviewing claims and benefits, coordinating provider and member outreach, preparing compliant correspondence, managing work queues, supporting audits, testing system upgrades, identifying trends, and providing cross-coverage for appeals. The role requires strong communication, organization, analytical judgment, confidentiality, and the ability to manage high-volume work accurately and within strict regulatory timelines.

Provides high-level administrative support to a Vice President, including calendar and meeting coordination, document and presentation preparation, database and records maintenance, travel arrangements, project coordination, provider scheduling and timecard processing, office operations, supply and expense management, onboarding support, and confidential communications.

Perform diagnostic ultrasound exams, operate and maintain ultrasound equipment, assess and document sonographic findings, ensure patient safety and comfort, maintain logs and billing, assist with daily operations and accreditation, and communicate results to physicians while upholding professional ethics.