Senior Grievances & Appeals Analyst

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The Senior Grievances & Appeals Analyst/ Professional analyzes and audits complaints received by the plan to ensure the integrity of claims, authorization processes, and business operations. You will report to the Associate Director, Grievances and Appeals, and be a part of the Resolution team.

As a Senior Grievances & Appeals Professional, you will:

+ Analyze and audit complaints received by the plan to ensure the integrity of claims, authorization processes, and business operations.
+ Utilize established process guidelines and industry knowledge to validate organizational decisions and assess downstream and upstream impacts
+ Perform root cause analysis of audit findings and make recommendations for appropriate change management.
+ Emphasize continuous improvement by identifying opportunities to reduce redeterminations, complaints, and rework of claims.
+ Identify trends and areas of improvement resultin...