Appeals and Grievances Analyst

Job Title: Appeals and Grievances AnalystLocation: Remote, USDuration: 6 Month ContractPay: $23-27/hr Position OverviewThe Appeals and Grievances Analyst is responsible for processing, analyzing, and resolving appeals and grievances in accordance with regulatory, contractual, and accreditation standards. This role involves researching case details, communicating outcomes to customers, and ensuring compliance with all state, federal, and Medicare/CMS regulations. The ideal candidate possesses strong analytical and writing skills, excels in a fast-paced environment, and demonstrates professionalism when engaging with members and internal stakeholders.Key ResponsibilitiesProcess appeals and grievances in alignment with regulatory and accreditation guidelines.Analyze and research case details to determine appropriate resolutions.Compose and issue clear, accurate, and professional response letters to customers.Contact members and providers to gather necessary information and communicate case dispositions.Apply state, federal, and CMS regulations in evaluating and finalizing appeals and grievances.Maintain accurate documentation and ensure compliance with internal quality and timeliness standards.Collaborate with cross-functional teams to resolve cases and improve overall process efficiency.Prioritize workload to manage multiple cases simultaneously in a fast-paced environment.Top 3 Required Skills/ExperienceProven ability to handle a high-volume workload efficiently in a fast-paced environment.Working knowledge of insurance and Medicare/CMS regulations.Strong customer service experience with the ability to handle sensitive inquiries professionally.Additional Required Skills/ExperienceExcellent written communication and letter-writing skills.Strong analytical and research abilities.Ability to multi-task and manage time effectively.Proficient in navigating computer systems and using Microsoft Office applications (Word, Excel, Outlook).Preferred Skills/ExperiencePrevious experience in grievances and appeals processing.Background in healthcare or insurance industries.Experience analyzing claims and differentiating between grievances, appeals, and organizational determinations.Strong project management or organizational skills.Comfortable learning new systems and performing basic computer tasks (e.g., saving PDFs, navigating spreadsheets).Education and CertificationsRequired: High School Diploma or GEDPreferred: Bachelor’s Degree in Healthcare, English, Communications, or a related field