What are the responsibilities and job description for the Appeals/Claims analyst position at W3R Consulting?
Are you a detail-oriented professional passionate about delivering exceptional customer service while navigating the complexities of healthcare appeals and grievances? Do you thrive in fast-paced environments, handling intricate cases with precision and care? If so, we have the perfect opportunity for you!
We’re hiring a Grievance & Appeals Analyst to join our team, working with a leading healthcare insurance provider. This fully remote role offers an initial 6 months contract with the potential for extension.
🔍 What You’ll Do
As a Grievance & Appeals Analyst, you will:
- Review, analyze, and process appeals and grievances, ensuring compliance with regulatory and accreditation guidelines.
- Conduct in-depth research to evaluate cases and provide comprehensive responses.
- Collaborate with customers to gather necessary information and effectively communicate case outcomes.
- Utilize your expertise to interpret contracts, state and federal regulations, and health insurance policies.
- Work efficiently in a high-volume environment, balancing multiple tasks and deadlines.
💡 What You Bring
Top 3 Required Skills/Experience:
- Proven ability to manage a high workload in a fast-paced environment, with strong computer proficiency.
- Knowledge of insurance, Medicare, and CMS regulations.
- Outstanding customer service experience with a customer-first mindset.
Additional Required Skills/Experience:
- Exceptional letter-writing and communication skills.
- Analytical thinking and problem-solving abilities.
- Strong research skills to evaluate and resolve complex cases.
- Multitasking skills to handle multiple priorities seamlessly.
Preferred Skills/Experience:
- Grievance and Appeals experience.
- Bachelor's degree in Healthcare or related field.
- Familiarity with claim analysis and differentiating between grievance, appeal, and organizational determination.
- Proficiency in saving PDFs, navigating Excel, and quickly learning new systems.
🎓 Education/Certifications:
- Bachelor’s Degree (Required)
🌐 Why Join Us?
- Work remotely from the comfort of your home.
- Contribute to improving the healthcare experience for customers.
- Be part of a dynamic, customer-focused team in a thriving industry.
- Build on your expertise in health insurance regulations, project management, and case analysis.
💻 Apply Today and Be a Part of a Team That’s Shaping the Future of Healthcare!
