Appeals and Grievances Analyst

Job Summary

A company is looking for an Appeals & Grievances Analyst.

Key Responsibilities

• Manage and coordinate member appeals and grievances in compliance with regulatory requirements
• Prepare cases for presentation to the Member Appeals Committee and provide written documentation of final dispositions
• Consult with subject matter experts and gather necessary documentation to resolve appeals and grievances

Required Qualifications, Training, and Education

• Associate's Degree or equivalent experience in health care or conflict resolution; Bachelor's Degree preferred
• 2-4 years of experience in customer service or member services within health care or insurance; 2 years of Appeals and Grievance experience preferred
• Knowledge of health care benefits and regulatory requirements preferred
• Proficiency in using computer applications, including Windows
• Ability to work independently and manage multiple tasks efficiently