Hybrid Paralegal II - ESH Quality Appeals & Grievances (Bronx Office & Work From Home)
Core
Provides legal, analytical, and operational support for Quality Appeals and Grievances functions, including research, compliance auditing, and data analysis.
Role type
Paralegal II (Healthcare Compliance & Appeals)
Builds
Regulatory compliance reports, appeal determinations, and process improvement insights for healthcare quality teams.
Domain
Healthcare / Managed Care / Regulatory Compliance
Deliverable
dashboards & analysis
Required skills
Legal research, regulatory compliance auditing, data analysis, report writing, Microsoft Office Suite, healthcare operations knowledge
Preferred skills
Paralegal certificate, associates degree, experience with external reviews and fair hearings
Technologies
Legal databases, regulatory resources, AI-enabled tools
Responsibilities
Initiate and analyze information for internal appeal decisions; audit Final Adverse Determination letters for compliance; develop weekly/monthly/quarterly reports on appeal data; research and prepare responses for external reviews and audits; identify trends and risks for process improvement.
Seniority
Mid-level, hands-on IC