UM Appeals Analyst

Job Summary

Supporting the Health Services and Utilization Management functions, the full-time UM Appeals Analyst will manage appeals cases, liaise between members and healthcare providers, and mentor junior staff while working remotely.

Key responsibilities:

• Review service requests for completeness and manage initial screening for UM Appeals requests
• Prepare, present, and schedule cases for the Member Appeals Committee (MAC) and provide administrative support throughout the appeals process
• Assist in mentoring junior staff and conduct root cause analysis to prevent future appeal occurrences

Required qualifications:

• High School Diploma/GED required
• Minimum of 5 years healthcare industry or operations experience
• At least 3 years of direct customer service experience, preferably in a medical support role
• Preferred experience with prior appeals handling and correspondence
• Knowledge of medical terminology and managed care principles is preferred