Healthcare Appeals Analyst

Job Summary

To support a meaningful impact on member outcomes, the full-time Healthcare Appeals Analyst will analyze and resolve appeals and grievances, ensuring compliance and timely resolutions in a remote environment.

Key responsibilities

• Analyze, research, and resolve appeals, grievances, and coding disputes in accordance with regulatory guidelines
• Prepare detailed case files and develop position statements for external reviews while documenting findings with high accuracy
• Collaborate with internal teams and providers to gather necessary clinical information and manage a dynamic caseload to meet deadlines

Required qualifications

• Bachelor's degree and 3+ years of related experience or 5+ years of relevant experience in lieu of a degree
• Experience in Medicare and/or insurance environments
• Familiarity with claims, appeals, and grievance processes (preferred)
• Coding certification or ability to obtain within 1 year for coding-focused roles
• Strong time management and case management skills to handle fluctuating workloads