Massachusetts Appeals Analyst

Job Summary

A company is looking for an Appeals and Grievance Analyst.

Key Responsibilities

• Act as a member advocate by clearly communicating the appeal and grievance process
• Manage assigned member appeals and grievance cases from documentation to resolution, ensuring compliance with regulatory requirements
• Review and interpret product and benefit designs according to State and Federal regulations

Required Qualifications

• Experience in managing appeals and grievances in a healthcare setting
• Knowledge of State and Federal regulatory requirements related to healthcare
• Ability to interpret healthcare benefits and product designs
• Experience in collecting and analyzing medical and administrative records
• Ability to consult with subject matter experts for resolution of issues