Appeals and Grievance Analyst

Job Summary

A company is looking for an Appeals and Grievance Analyst.

Key Responsibilities

• Manage and coordinate member appeals and grievances in compliance with State and Federal regulations
• Prepare cases for presentation and participate in discussions at the Member Appeals Committee
• Act as a member advocate, clearly communicating the appeal and grievance process

Required Qualifications

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