Appeals Analyst - Missouri

Job Summary

Processing complaints and appeals, the full-time Appeals Analyst - Missouri will gather information, document resolutions, and communicate actions while working remotely with management approval based on business needs and performance.

Key responsibilities

• Gather and review information to determine resolutions for complaints, grievances, and appeals
• Document work according to department Standard Operating Procedures to ensure clarity and consistency
• Develop timely and accurate responses to complaints and ensure compliance with relevant regulations and procedures

Required qualifications

• Bachelor's degree in business, finance, accounting, law, health care administration, or relevant experience in the health insurance industry
• 1-3 years of experience in a health insurer role related to customer claim or benefit issues
• Ability to communicate effectively with members, providers, and internal teams
• Working knowledge of member health benefit certificates and BCBSKC medical policies
• Familiarity with federal, state, and accreditation requirements related to complaints and appeals