Appeals Analyst

Job Summary

Reviewing and responding to appeals and inquiries, the full-time Appeals Analyst will work remotely to ensure compliance with federal and state laws while exercising independent judgment on adverse benefit determinations.

Key responsibilities

• Analyzes and responds to inquiries and complaints from members, providers, and regulatory bodies regarding appeals
• Maintains administrative records of case files and monitors the status of appeals while preparing written analyses for response
• Recommends changes to the appeals process and contract language to minimize legal and regulatory liability

Required qualifications

• Bachelor's degree in a related field or five years of relevant experience
• Minimum of three years' experience in healthcare grievances, appeals, claims processing, or related legal experience
• Working knowledge of insurance products, policies, and claims processing preferred
• Experience using Microsoft Office, particularly Word and Excel
• Ability to maintain HIPAA and legal confidentiality