Appeals Analyst

At least three years of relevant experience in healthcare grievances, appeals, claims processing, claims research, customer service, or related legal work. Review claims and denial information, determine the appropriate internal reviewer or responder, and draft clear, professional letters related to claims and appeals.

Appeals Analyst


Job Summary

Review claims and denial information, determine the appropriate internal reviewer or responder, and draft clear, professional letters related to claims and appeals.

Responsibilities

• Review claims and denial information.
• Determine who within the organization should review or respond to each denial.
• Draft professional letters related to claims and appeals.
• Communicate clearly and professionally about clinical or healthcare-related situations.

Requirements

• Healthcare experience required.
• At least three years of relevant experience in healthcare grievances, appeals, claims processing, claims research, customer service, or related legal work.
• Claims or appeals experience preferred.
• Bachelor s degree in a related field preferred.
• Writing/Drafting Appeal letters
• Five additional years of relevant experience may substitute for the degree.

Skill

• Strong professional writing skills.
• Problem-solving and research skills.
• Working knowledge of insurance products, policies, procedures, or claims processing preferred.
• Proficiency with Microsoft Office, particularly Microsoft Word and Excel.

Summary Qualification

• Healthcare and claims-related experience.
• Excellent written communication and research abilities.
• Ability to analyze denials and identify the appropriate response process.
• Ability to write clear, professional correspondence involving clinical or healthcare matters.

 

Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status.