Remote Grievance and Appeals Analyst Lead

Location: Colorado, Florida, Georgia, Indiana, Ohio, Tennessee, Texas

Compensation: To Be Discussed

Staff Reviewed: Wed, Nov 04, 2020

This job expires in 2 days

Job Category: Accounting

Remote Level: Partially Remote

Weekly Hours: Full Time

Employer Type: Employer

Career Level: Experienced

Education Level: Some College, Bachelors

Job Summary

A health insurance company has a current position open for a Remote Grievance and Appeals Analyst Lead.

Must be able to:

  • Monitor workflow and make assignments to ensure the correct team resource is utilized to achieve accreditation and regulatory compliance metrics in a quality manner
  • Provide review and analysis of complex pre-service and post-service grievances and appeals requests from customers and multiple products related to clinical and non-clinical services, quality of service, and quality of care issues
  • Coach, train, and audit to ensure the team correctly utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records

Qualifications for this position include:

  • Reside within a commutable distance (50 miles) of a Company office location; target locations include: OH, IN, FL, TX, GA, CO, TN
  • Ability to work some weekend hours (occasional overtime)
  • HS diploma or equivalent
  • 3 to 5 years of Grievance & Appeals Senior analyst experience; or any combination of education and experience, which would provide an equivalent background
  • Demonstrated strong oral, written and interpersonal communication skills
  • Proven strong problem-solving, facilitation, and analytical skills