Job Summary
A company is looking for an Appeals & Grievances Analyst.
Key Responsibilities
- Manage and coordinate member appeals and grievances in compliance with regulatory requirements
- Prepare cases for presentation to the Member Appeals Committee and provide written documentation of final dispositions
- Consult with subject matter experts and gather necessary documentation to resolve appeals and grievances
Required Qualifications, Training, and Education
- Associate's Degree or equivalent experience in health care or conflict resolution; Bachelor's Degree preferred
- 2-4 years of experience in customer service or member services within health care or insurance; 2 years of Appeals and Grievance experience preferred
- Knowledge of health care benefits and regulatory requirements preferred
- Proficiency in using computer applications, including Windows
- Ability to work independently and manage multiple tasks efficiently
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