Appeals and Grievance Analyst

Job Summary

A company is looking for an Appeals and Grievance Analyst.

Key Responsibilities

• Manage and coordinate member appeals and grievances in compliance with regulatory requirements
• Prepare cases for presentation at the Member Appeals Committee and develop written documentation for members
• Consult with subject matter experts and gather necessary information for case resolution

Required Qualifications, Training, and Education

• Associate's Degree or equivalent experience in healthcare, conflict resolution, or related field required; Bachelor's Degree preferred
• 2-4 years of experience in customer service or member services within healthcare or insurance required; 2 years of Appeals and Grievance experience preferred
• Health care benefit and regulatory knowledge preferred
• Proficiency in operating computers and related software applications
• Ability to work independently and collaboratively while managing multiple tasks efficiently