Texas Licensed Appeals Analyst

Job Summary

A company is looking for an Appeals and Grievance Analyst who will manage and coordinate member appeals and grievances in compliance with regulations.

Key Responsibilities

• Act as a member advocate by communicating the appeal and grievance process
• Manage member appeals and grievance cases from documentation to resolution
• Review and interpret product and benefit designs according to regulatory requirements

Qualifications

• Associates Degree or equivalent experience in health care or conflict resolution
• 3-5 years of health care or insurance experience
• Preferred knowledge of health care benefits and regulatory requirements
• Experience with insurance products, policies, and procedures is preferred
• Ability to work independently and collaboratively as part of a team