Appeals and Grievance Analyst

Role Overview

• Act as a member advocate; clearly communicating the appeal and grievance process and procedures
• Manage assigned member appeals and grievance cases from documentation, investigation, and through resolution
• Ensure compliance with regulatory requirements during final disposition
• Review product and benefit designs according to regulations
• Consult with subject matter experts for resolution of matters

Requirements

• Strong customer service and benefit interpretation skills
• Ability to manage assigned member appeals and grievance cases
• Knowledge of NCQA, DOI, CMS, DOL and state or federal specific regulations
• Ability to review and interpret product and benefit designs
• Experience in collecting documents and records for appeals

Benefits

• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition program
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health