Appeals Resolution Analyst I

March 18

🦌 Connecticut – Remote

Although this job is listed in Connecticut, this company may be open to hiring remote in other states.

🏖️ New Jersey – Remote

Although this job is listed in New Jersey, this company may be open to hiring remote in other states.

+2 more states

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $49.4k - $66k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

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NJM Insurance Group

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NJM Insurance Group is a well-established insurance provider offering a range of personal and commercial insurance products. Their services include auto, homeowners, renters, condo, commercial auto, and business insurance, with a focus on exceptional customer satisfaction and claims experience. NJM is recognized for its outstanding auto claims experience by J. D. Power and is committed to serving customers in states like Connecticut, Maryland, New Jersey, Ohio, and Pennsylvania. The company prides itself on being straightforward and customer-focused, without jingles or mascots, offering trusted insurance solutions and multiple discount opportunities for various policies.

Auto Insurance • Workers'​ Compensation Insurance • Homeowners Insurance • Commercial Auto Insurance • Renters Insurance

1001 - 5000 employees

Founded 1913

📋 Description

• Responsible for efficient functioning of the appeals resolution correspondence unit. • Input and update demographic customer and clinical data for utilization management programs. • Contribute to the maintenance of a competent staff by assisting training new Analysts. • Act as a resource for Review Specialist providing guidance and coaching. • Compile and tabulate data on utilization management programs. • Monitor phone queue and make personnel adjustments as needed. • Monitor Appeals processing to meet NCQA, State, and DOBI requirements. • Assist in mandatory reporting both internal and external. • Develop and implement workflows specific to Appeals department. • Perform staff audits and silent auditing of the phone queue. • Serve as liaison for Medicaid Fair Hearings ensuring compliance during appeals process. • Assist in the completion of Delegate Vendor Audits.

🎯 Requirements

• High School Diploma/GED required. • Requires a minimum of two (2) years utilization management or appeals experience. • Requires knowledge of health care delivery systems. • Requires knowledge of community resources. • Requires knowledge of CPT-4 and ICD-9 coding. • Requires knowledge of current Medical Management system. • Requires strong oral and written communication skills. • Requires strong analytical and logical thinking. • Requires use of good grammar, diction and articulation. • Prefer ability to type 25 wpm.

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement