Grievance and Appeal Analyst

Job Summary

To support the resolution of member and provider concerns, the full-time Grievance and Appeal Analyst will investigate, analyze, and resolve grievances and appeals while ensuring compliance with regulatory timelines in a fully remote setting.

Key responsibilities

• Investigate and resolve member, provider, and health plan partner grievances and appeals
• Review and analyze pre-service and post-service denials to identify discrepancies and appropriate resolutions
• Draft clear, professional written responses explaining decisions and benefit determinations

Required qualifications

• Bachelor's degree or equivalent combination of education and relevant work experience
• 3+ years of dental industry experience
• 2+ years of administrative experience in a healthcare setting
• Intermediate proficiency in Microsoft Word and Excel
• Ability to manage multiple cases and meet strict regulatory deadlines in a fast-paced environment