Appeals Analyst

E-Verify Program

Appeals Analyst researching, analyzing, and processing appeals and grievances in healthcare. Ensuring compliance with regulatory standards while supporting customer satisfaction and timely outcomes.

Posted 6/12/2026full-timeKentucky, North Carolina, South Carolina, Wisconsin, Wyoming • 🇺🇸 United StatesMid-LevelSenior💰 $50,337 - $80,539 per yearWebsite

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

coding disputeshealth plan benefitsmedical terminologyregulatory complianceaccreditation guidelinesclinical appealshealthcare claims adjudicationanalytical skillscritical thinking

Soft Skills

judgmentdecisivenessorganizational skillsprioritizationadaptability

Tools & Technologies

Microsoft OfficeExcel

Certifications & Qualifications

Bachelor’s degreeCertified Professional CoderAAPC certification

Industry Keywords

BlueCross NCMedicareCommercial CMS guidelinesappealsgrievances

About the role

Key responsibilities & impact

Analyze, research, resolve and respond to confidential/sensitive appeals, coding disputes, grievances and coverage/organization determinations.
Analyze, interpret, and explain health plan benefits, policies, procedures, medical terminology, coding to members and/or providers.
Regularly and independently exercise judgement to make appropriate decisions based on BlueCross NC policies and guidelines.
Acts decisively to ensure business continuity and with awareness of all possible implications and impact.
Prepare files and develops BlueCross NC position statements for external reviews performed by independent review organizations, benefit panels and external medical consultants.
Provide comprehensive appeals, coding disputes and grievances responses that support the decision and comply with regulatory and accreditation guidelines.
Document extensive investigation, relative findings, and actions in all applicable systems.
Accountable for monitoring daily reports to ensure service timeliness and compliance is met.
Gather clinical information by using established criteria provided in corporate medical policies; partner with Medical Directors who are responsible for all decisions regarding clinical appeals/grievances.
Ensures timeliness, quality, and efficiency in all work to comply with applicable mandated State and/or Federal accreditation agency standards.

Requirements

What you’ll need

Bachelor’s degree or advanced degree where required.
3 years of related experience.
In lieu of degree, 5 years of related experience.
For coding disputes area, certified professional coder must be obtained within 1 year of employment.
Certified Professional Coder through AAPC – Highly preferred.
Healthcare Claims adjudication appeals or reimbursement experience – Highly preferred.
Experience with Payor or Provider appeals – Highly Preferred.
Knowledge of Medicare and/or Commercial CMS guidelines - Highly Preferred.
Strong analytical and critical thinking abilities.
Excellent organizational skills.
Ability to prioritize competing deadlines.
Experience working in fast-paced environment.
Proficiency in Microsoft Office and Excel.

Benefits

Comp & perks

Work-life balance, flexibility, and the autonomy to do great work.
Medical, dental, and vision coverage along with numerous health and wellness programs.
Parental leave and support plus adoption and surrogacy assistance.
Career development programs and tuition reimbursement for continued education.
401k match including an annual company contribution.