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Corewell Health is seeking a Member Appeal Analyst to handle complex member appeal investigations and ensure compliance with regulatory requirements. The role requires strong analytical skills and the ability to collaborate with various stakeholders, while contributing to a culture focused on personalized healthcare and community support.
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Job Summary
The role is responsible for the thorough investigation of complex member appeals and fair hearing reviews while ensuring strict adherence to regulatory time lines.
Candidates must collaborate with internal executives, Medical Directors, and external providers to resolve issues before they reach the Appeal Committee or Independent Review Organization stage.
Corewell Health offers a comprehensive benefits package including on-demand pay, retirement matching, and a commitment to cultivating an inclusive culture where team members can bring their whole selves to work.
Matching Summary
Match Score: 75
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Corewell Health is seeking a Member Appeal Analyst to handle complex member appeal investigations and ensure compliance with regulatory requirements. The role requires strong analytical skills and the ability to collaborate with various stakeholders, while contributing to a culture focused on personalized healthcare and community support.
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Skills & Requirements
Must-have
Complex member appeal investigations
Regulatory compliance with state and federal laws
Analysis of medical policies and plan documents
Collaboration with Medical Directors and Legal teams
Management of expedited 72-hour review timelines
Nice-to-have
Strong critical thinking and analytical skills
Experience with grievance and appeals processes
Knowledge of Priority Health enterprise systems
Ability to communicate complex issues clearly
Commitment to diversity, equity, and inclusion
Key Requirements
Associate's degree required
2 years of relevant experience in customer service, claims, legal, or enrollment
Previous experience with grievance and appeals processes preferred
Working knowledge of managed care products and accreditation requirements