Senior Appeals and Grievance Analyst

Role Overview

• Reviewing and processing appeals and grievances submitted by Members and Providers
• Documenting and investigating the substance of the appeal, grievance, or complaint
• Notifying involved parties of the outcome of a review
• Providing excellent customer services to members, providers and CMS
• Maintaining knowledge of and adhering to CMS regulations and guidelines

Requirements

• Associates degree or equivalent work experience required
• 2 years
• Customer service and/or claims experience
• 1 year – Medicare Advantage customer service and claims experience required
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Proficient oral and written communication skills
• Proficient interpersonal and organizational skills
• Ability to work independently
• Capacity to solve problems and manage multiple assignments with critical deadlines
• Knowledge of CMS regulations and guidelines related to appeals, grievances and complaints

Benefits

• Health insurance
• 401(k)
• Flexible work arrangements
• Paid time off
• Professional development opportunities