Dispute and Appeals Analyst

Job Summary

A company is looking for a Dispute and Appeals Analyst to support the resolution of member grievances and appeals.

Key Responsibilities

• Analyze and research service denials or modifications and gather relevant information for appeals
• Collaborate with various stakeholders to ensure timely and accurate resolution of grievances and appeals
• Document final determinations and prepare cases for presentation to resolution teams

Required Qualifications

• 2+ years of experience with appeals, grievances, and member complaints
• Experience presenting cases to Administrative Law Judges at state fair hearings
• Proficiency in Microsoft Office and familiarity with Windows PCs
• Ability to compose clear written correspondence and translate complex terms for members
• Flexibility to work outside of standard hours as needed