Senior Appeals Analyst
Highmark Health
full-time
Posted on:
Location Type: Hybrid
Location: Louisiana • Maryland • United States
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Salary
💰 $23 - $36 per hour
Job Level
About the role
- Review inquiries to determine if they meet definition of appeal/grievance.
- Request and review all related relevant documentation and assemble case file.
- Coordinate resolution results and relay investigative results with all involved parties.
- Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross functional teams to reduce trends.
- May support the Quality Assurance, Appeal and other quality committees.
- Other duties as assigned or requested.
Requirements
- High School Diploma or GED
- 5-10 years of relevant, progressive experience in the area of specialization
- Experience in Customer Service or a related field
- Knowledge of multiple processing systems and workflows
- Knowledge of claims processing methodologies
- Ability to interpret all government regulations
- Knowledge of company products
- Excellent organizational skills
- Strong verbal and written communication skills
Benefits
- Health insurance
- 401(k) plan
- Paid time off
- Flexible work arrangements
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims processing methodologiesprocessing systemsworkflow management
Soft Skills
organizational skillsverbal communicationwritten communication
Certifications
High School DiplomaGED