Senior Appeals and Grievance Analyst
BlueCross BlueShield of Tennessee
full-time
Posted on:
Location Type: Remote
Location: Tennessee • United States
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Job Level
About the role
- Reviewing and processing appeals and grievances submitted by Members and Providers
- Documenting and investigating the substance of the appeal, grievance, or complaint
- Notifying involved parties of the outcome of a review
- Providing excellent customer services to members, providers and CMS
- Maintaining knowledge of and adhering to CMS regulations and guidelines
Requirements
- Associates degree or equivalent work experience required
- 2 years - Customer service and/or claims experience
- 1 year – Medicare Advantage customer service and claims experience required
- Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
- Proficient oral and written communication skills
- Proficient interpersonal and organizational skills
- Ability to work independently
- Capacity to solve problems and manage multiple assignments with critical deadlines
- Knowledge of CMS regulations and guidelines related to appeals, grievances and complaints
Benefits
- Health insurance
- 401(k)
- Flexible work arrangements
- Paid time off
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
customer serviceclaims experienceMedicare Advantage customer serviceMicrosoft Officeproblem solvingdocumentationinvestigation
Soft Skills
oral communicationwritten communicationinterpersonal skillsorganizational skillsindependent worktime management
Certifications
Associates degree