Member Appeals Grievance Analyst

Job Summary

A company is looking for a Member Appeals & Grievance Analyst.

Key Responsibilities

• Document and investigate appeals, grievances, or complaints, including clinical care or reimbursement issues
• Notify involved parties of review outcomes, ensuring compliance with CMS timelines
• Provide excellent customer service to members, providers, and CMS while adhering to regulations

Required Qualifications

• Associates degree or equivalent work experience required
• 2 years of customer service and/or claims experience
• 1 year of Medicare Advantage customer service and claims experience required
• Proficient in Microsoft Office (Outlook, Word, Excel, PowerPoint)
• Knowledge of CMS regulations related to appeals, grievances, and complaints