Healthcare Appeals Analyst

Job Summary

Working remotely on a temporary basis, the Appeals Analyst will review and respond to appeals and inquiries regarding adverse benefit determinations, ensuring compliance with legal standards and exercising impartial judgment.

Key responsibilities

• Review and evaluate inquiries related to adverse benefit determinations within legal and regulatory timeframes
• Respond to appeals with impartial judgment, ensuring adherence to applicable laws and contract obligations
• Document case summaries and communicate findings efficiently to relevant stakeholders

Required qualifications

• 3+ years of experience in healthcare grievances, appeals, claims processing, or related legal experience
• Working knowledge of insurance products, policies, procedures, and claims processing (preferred)
• Bachelor's degree in a related field or 5+ years of relevant experience in lieu of a degree
• Proficiency in Microsoft Office, including Word and Excel
• Ability to handle sensitive information with discretion