Appeals Analyst

Role Overview

• Review inquiries to determine if they meet definition of appeal/grievance.
• Request and review all related relevant documentation and assemble case file.
• Coordinate resolution results and relay investigative results with all involved parties.
• Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross functional teams to reduce trends.

Requirements

• 3-5 years of relevant, progressive experience in the area of specialization.
• Knowledge of multiple processing systems and workflows.
• Knowledge of claims processing methodologies.
• Ability to interpret all government regulations.
• Excellent organizational skills.
• Strong verbal and written communication skills.