Texas Appeals Quality Analyst

Job Summary

A company is looking for an Appeals and Grievances Quality Analyst to lead quality reviews and support process improvements in a remote setting.

Key Responsibilities

• Analyze eligibility data and review CMS transaction reports to identify errors and optimize workflows
• Monitor appeals and grievances for timeliness and accuracy, ensuring documentation consistency
• Train new Appeals & Grievances Coordinators and support the development of training materials

Required Qualifications

• High School diploma or equivalent
• 3+ years of experience with Healthcare Appeals and Grievances
• 2+ years of Medicare Advantage experience
• Knowledge of CMS Regulations related to Appeals and Grievances
• Demonstrated analytical skills including file format manipulation and data comparison