Appeals Analyst

Company : reputed company HealthJob reputed company : reputed company job reviews inquiries to determine if they meet the definition of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals; initiates a case file for reputed company grievance and appeal; ensures compliance with organizational and regulatory requirements for member or provider issues; independently coordinates the reputed company with internal/external parties as required; and documents and summarizes to reputed company parties involved in the case the investigation results. ESSENTIAL RESPONSIBILITIES

• Review inquiries to determine if they meet definition of appeal/grievance.
• Request and review reputed company reputed company relevant documentation and reputed company case file.
• Coordinate reputed company results and reputed company investigative results with reputed company 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.
• May support the reputed company Assurance, Appeal and other reputed company committees.
• Other duties as assigned or requested.

EDUCATION Required

• High School Diploma or GED

Substitutions

• None

Preferred

• None

EXPERIENCE Required

• 3-5 years of relevant, reputed company experience in the area of specialization. Exempted experience requirements effective August 2016.

Preferred

• Experience in Customer Service or a reputed company field

LICENSES or CERTIFICATIONS Required

• None

Preferred

• None

SKILLS

• Knowledge of multiple processing systems and workflows
• Knowledge of claims processing methodologies
• Ability to interpret reputed company government regulations
• Knowledge of company products
• Excellent organizational skills
• Strong verbal and written communication skills

Languages (Other than English) None Travel Requirement 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Occasionally Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required reputed company Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Occasionally Disclaimer: The job reputed company has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the reputed company of business conduct and company policies. As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company must reputed company with both the Health Insurance Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirements. Pay reputed company Minimum: $21.53 Pay reputed company Maximum: $32.30 reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations. The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations based upon comparative markets. reputed company and its affiliates prohibit discrimination against reputed company individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law. We reputed company to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@reputed company.org California Consumer reputed company reputed company Employees, Contractors, and Applicants Notice Apply tot his job Apply To this Job