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 regulatory requirements
• Act as a member advocate by clearly communicating the appeal and grievance process
• Prepare documentation and participate in discussions at the Member Appeals Committee

Required Qualifications

• Associate's Degree or equivalent experience in healthcare or related field; Bachelor's Degree preferred
• 2-4 years of experience in customer service or member services in healthcare or insurance; 2 years of Appeals and Grievance experience preferred
• Knowledge of healthcare benefits and regulatory requirements preferred
• Proficiency in using computer systems and applications
• Ability to work independently and collaboratively in a team environment