Appeals and Grievance Analyst

Job Summary

Working remotely, the full-time Appeals and Grievance Intake Analyst will manage the intake process by reviewing and analyzing documents, accurately transferring data into internal systems, and ensuring cases are distributed to appropriate teams for processing.

Key responsibilities

• Receive, triage, and distribute work from various sources, documenting the substance of appeals or grievances in applicable systems
• Follow up with members and providers for additional information needs, ensuring detailed documentation of inquiries and related notes
• Maintain knowledge of CMS regulations and guidelines affecting the appeal/grievance process while ensuring timely correspondence

Required qualifications

• High School Diploma or equivalent
• 1 year of experience in claims or customer service
• Exceptional documentation abilities and organizational skills
• Proficient with Facets, CareAdvance, and Imaging
• Knowledge of CMS regulations related to appeals, grievances, and complaints