Senior Appeals Analyst

Highmark Health

Working At Home, PA, United States
Base: $23.16 - $35.88; bonus/equity: not specified...
Review appeals and grievances
Document investigation results
Coordinate with internal/external parties
The Appeals Analyst reviews inquiries to determine if they meet the definition of a grievance/appeal

Job Summary

  • The Appeals Analyst reviews inquiries to determine if they meet the definition of a grievance/appeal.
  • The role involves documenting, investigating, referring, and coordinating grievances and appeals, ensuring compliance with organizational and regulatory requirements.
  • Responsibilities include coordinating resolution with internal/external parties and documenting investigation results for all involved parties.

Matching Summary

The Appeals Analyst reviews inquiries to determine if they meet the definition of a grievance/appeal.

Salary

Base: $23.16 - $35.88; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Must-have

  • Review appeals and grievances
  • Document investigation results
  • Coordinate with internal/external parties
  • Ensure regulatory compliance
  • Process claims methodologies

Nice-to-have

  • Participate in workgroup meetings
  • Support quality committees
  • Strong communication skills

Key Requirements

  • 5-10 years relevant experience
  • High School Diploma or GED
  • Knowledge of multiple processing systems
  • Ability to interpret government regulations

Work Rights

Not specified

Tailored Resume

Cover Letter