Grievance/Appeals Analyst I (US)
Core
Entry-level analyst reviewing, analyzing, and processing non-complex pre-service and post-service grievances and appeals for members, providers, and regulators across various health insurance products.
Role type
Entry-level Grievance and Appeals Analyst
Builds
Written determinations and responses for grievances and appeals
Domain
Health Insurance / Claims Support
Deliverable
client delivery
Required skills
Grievance and appeals processing, Claims analysis, Regulatory compliance, Medical record review, Written communication
Preferred skills
Business writing, Provider network understanding, Medical management process knowledge, Claims process knowledge, Internal technology proficiency
Technologies
Internal local technology
Responsibilities
Review and analyze non-complex grievances and appeals, Utilize guidelines and tools to research claims and medical records, Render determinations on assigned issues, Complete written communication documents, Serve as liaison between departments
Seniority
Entry-level, Non-Management Non-Exempt