Appeals Analyst – REMOTE

Hi We have an urgent role of Appeals Analyst – REMOTE. URGENT HIRE! Appeals Analyst – REMOTE Schedule - Remote - 8am - 4:30pm Position Type: Contract Position Length: Unsure, at least through the end of 2026 – def could extend for an entire year ! Target Start Date: ASAP Required Skills, Knowledge, and Experience: • Bachelor’s degree in related field. In lieu of degree, five (5) years' relevant experience will be considered in addition to the experience requirements listed below. • Minimum three (3) years' healthcare grievances, appeals, claims processing, claims research, customer service or related legal experience. • Working knowledge of insurance products, policies, procedures and/or claims processing preferred. • Experience using Microsoft Office i.e. Word and Excel. Duties: The Appeals Analyst reviews and responds to appeals and inquiries from members, providers, authorized representatives, insurance departments, and/or other regulatory bodies regarding adverse benefit determinations within the timeframes set forth in both federal and state law. This position must favor neither the Company nor the member and must exercise independent judgment in determining whether an adverse benefit determination was legal, appropriate, impartial and in accordance with the enterprise’s obligation under the applicable contract. Skills: EXPERIENCE & KNOWLEDGE Minimum three (3) years' healthcare grievances, appeals, claims processing, claims research, customer service or related legal experience. Working knowledge of insurance products, policies, procedures and/or claims processing preferred. Experience using Microsoft Office i.e. Word and Excel. ESSENTIAL ABILITIES Sound Judgement HIPAA Confidentiality Legal Confidentiality Taking Initiative