• Updates and maintains numerous Tufts Health Plan insurance benefit documents for individual and employer group (insured and self-insured) business for submission to state regulators.• Assures response to inquiries from various internal departments at Tufts Health Plan regarding benefit documents and state/federal legislation involving mandated benefits.• Utilizes Microsoft Access or other applicable database software to input Evidence of Coverage change requests into Legal Department databases.• Reviews all other communication materials as needed for consistency with benefit document provisions, state and federal law, and internal Tufts Health Plan guidelines.• Co-chairs Benefit Contract Development staff in internal meetings on matters involving benefit documents and applicable state-mandated and federal benefits.

• Confirms all regulatory requirements in department databases.• Collaborates with Supervisors, Managers, Clinical Specialists, Grievance Specialists, Medical Directors, Case Management, Clinical Review, Legal, and other internal departments in an effort to facilitate identification and resolution of appeal and analyze the overall appeals procedures.• Chairs and plans intra-departmental meetings.• Assures all regulatory and department timelines are consistently met.• Orient new Commercial Appeals and Grievances Specialists.• Assisted in the coordination of the internal appeals audit for the National Committee for Quality Assurance (NCQA) that helped lead to the successful outcome of the NCQA survey.• Conduct the quarterly audit for the UM Compliance Steering Committee Meeting and assigns follow-up action items and implements necessary changes.• Oversee/Design content and presentation of case reviews for monthly Schwartz rounds for physicians and clinicians• Provides proofreading for all Commercial Appeals and Grievances Specialists for all written correspondence