Appeals Analyst

Highmark Inc.

Working At Home, PA, United States
Base: $21.96 - $32.95; bonus/equity: not specified...
Review inquiries for grievance/appeal definition
Document and investigate grievances/appeals
Coordinate resolution with parties
This job reviews inquiries to determine if they meet the definition of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals

Job Summary

  • This job reviews inquiries to determine if they meet the definition of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals.
  • Ensures compliance with organizational and regulatory requirements for member or provider issues; independently coordinates the resolution with internal/external parties as required.
  • Participates in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross functional teams to reduce trends.

Matching Summary

This job reviews inquiries to determine if they meet the definition of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals.

Salary

Base: $21.96 - $32.95; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Must-have

  • Review inquiries for grievance/appeal definition
  • Document and investigate grievances/appeals
  • Coordinate resolution with parties
  • Ensure regulatory compliance
  • Knowledge of multiple processing systems

Nice-to-have

  • Participate in workgroup meetings
  • Process improvement initiatives
  • Cross-functional team collaboration
  • Strong organizational skills
  • Excellent communication skills

Key Requirements

  • 3-5 years relevant progressive experience
  • High School Diploma or GED
  • Experience in Customer Service or related field preferred

Work Rights

Not specified

Tailored Resume

Cover Letter