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 to the Member Appeals Committee and provide written documentation of final dispositions
• Act as a member advocate, ensuring clear communication of the appeal and grievance processes

Required Qualifications, Training, and Education

• Associate's Degree or equivalent experience in health care, conflict resolution, or a 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 collaboratively while managing multiple priorities