Appeals and Grievance Analyst

Job Summary

A company is looking for an Appeals and Grievance Analyst.

Key Responsibilities

• Act as a member advocate, managing assigned member appeals and grievance cases from documentation to resolution
• Review and interpret product and benefit designs according to regulatory requirements
• Consult with subject matter experts and make recommendations on appeal decisions based on member benefits

Required Qualifications, Training, and Education

• Associates Degree or equivalent experience in health care, conflict resolution, or a related field
• 3-5 years of health care or insurance experience
• Health care benefit and regulatory knowledge preferred
• Knowledge of insurance products, policies, and procedures preferred