Appeals and Grievance Analyst

Job Summary

A company is looking for an Appeals and Grievance Analyst.

Key Responsibilities

• Act as a member advocate by clearly communicating the appeal and grievance process
• Manage assigned member appeals and grievances, ensuring compliance with regulatory requirements
• Review and interpret product and benefit designs for all lines of business

Required Qualifications, Training, and Education

• Associate's Degree or equivalent experience in health care, conflict resolution, or related field (Bachelor's preferred)
• 2-4 years' experience as a customer service or member services representative in health care or insurance (2 years' Appeals and Grievance experience preferred)
• Health care benefit and regulatory knowledge preferred
• Proficiency in operating a computer and related applications
• Ability to organize, plan, and implement functions of Member Appeals and Grievances