Appeals Analyst

**Job Description**

We are seeking an Appeals Analyst to research, analyze, and process appeals, coding disputes, and grievances. In this role, you will ensure work is completed timely, accurately documented, and aligned with legislative and regulatory requirements, quality standards, and organizational policies and procedures. You will also help resolve customer concerns with a focus on timely outcomes and customer satisfaction.

**What You’ll Do**

+ Analyze, research, resolve and respond to confidential/sensitive appeals, coding disputes, grievances and coverage/organization determinations from members, member's representatives, providers, media outlets, senior leadership and regulatory agencies with established regulatory and accreditation guidelines.
+ Analyze, interpret, and explain health plan benefits, policies, procedures, medical terminology, coding and functions to members and/or providers.
+ Regularly and independently exercise judgement to ma...