Member Appeals Analyst

Job Summary

Reviewing and processing member and provider appeals and grievances, the full-time remote Member Appeals Analyst will ensure timely resolution in compliance with CMS and Medicare guidelines while managing multiple priorities and improving member experience.

Key responsibilities

• Documenting and investigating the substance of appeals, grievances, or complaints and the actions taken
• Notifying involved parties of the outcomes of reviews, including compliance with CMS regulations
• Providing excellent customer service to members, providers, and CMS while maintaining regulatory knowledge

Required qualifications

• Associate's degree or equivalent work experience required
• 2 years of customer service and/or claims experience
• Proficiency in Microsoft Office (Outlook, Word, Excel, and PowerPoint)
• Knowledge of CMS regulations and guidelines related to appeals, grievances, and complaints
• Experience in a healthcare setting is preferred