Appeals and Grievance Analyst

Job Summary

A company is looking for an Appeals and Grievance Analyst.

Key Responsibilities

• Manage and coordinate assigned member appeals and grievances in compliance with regulatory requirements
• Prepare cases for presentation and participate in discussions at the Member Appeals Committee
• Act as a member advocate by clearly communicating the appeal and grievance process

Required Qualifications

• Associate's Degree or equivalent experience in health care, conflict resolution, or related field (Bachelor's preferred)
• 2-4 years of experience in customer service or member services in health care or insurance (2 years in Appeals and Grievance preferred)
• Knowledge of health care benefits and regulatory requirements preferred
• Proficiency in using computer applications and systems
• Ability to work independently and prioritize tasks effectively