Appeals Analyst

5 days ago

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Highmark Health

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health care

10,000+

💰 $5M Grant on 2021-05

Description

• This 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 each grievance and appeal; • ensures compliance with organizational and regulatory requirements for member or provider issues; • independently coordinates the resolution with internal/external parties as required; • documents and summarizes to all parties involved in the case the investigation results.

Requirements

• Required 3-5 years of relevant, progressive experience in the area of specialization. • Preferred Experience in Customer Service or a related field. • Required High School Diploma or GED