Appeals and Grievance Analyst- Senior Care Division

Employer Industry: Healthcare Services

• Opportunity for career advancement and growth within the organization
• Fully remote work opportunity with a flexible schedule
• Competitive salary with the potential for bonuses
• Supportive and collaborative work environment
• Chance to make a positive impact on member satisfaction and compliance with CMS guidelines

• Review and process appeals and grievances submitted by members and providers
• Document and investigate the substance of appeals, grievances, or complaints
• Notify involved parties of the outcome of reviews, including approvals and denials
• Provide excellent customer service to members, providers, and CMS
• Maintain knowledge of and adhere to CMS regulations affecting the appeals/grievance process

• Associate's degree or equivalent work experience required
• Minimum of 2 years of customer service and/or claims experience
• At least 1 year of Medicare Advantage customer service and claims experience required
• Proficient in Microsoft Office (Outlook, Word, Excel, and PowerPoint)
• Strong oral and written communication skills

• Experience with the appeals and grievance process
• Clinical background or experience in a healthcare setting
• Familiarity with approved AI tools to enhance work efficiencies

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