Senior Compliance Analyst - Grievance & Appeals

SCAN Health Plan; Brasil; Teletrabalho; BRL 481.000 - 589.000; Tempo integral

Resumo da oferta

A leading healthcare organization in Brazil is seeking an experienced compliance professional to oversee Medicare Advantage Appeals and Grievances. The ideal candidate will have over 5 years of related experience, strong project management skills, and exceptional communication abilities. This role emphasizes flexible work arrangements and offers a base salary up to $103,732 annually, along with generous PTO and an annual bonus program.

Serviços

Base salary up to $103,732

Annual employee bonus

Generous paid time off

Tuition reimbursement

Qualificações

• 5+ years of experience in Medicare Advantage Appeals & Grievances.
• Strong project management experience in a fast-paced environment.
• Exceptional oral and written communication skills.

Responsabilidades

• Monitor grievance and appeal processes for compliance.
• Document discrepancies and work with teams to resolve issues.
• Provide feedback for continuous improvement in reviews.

Conhecimentos

Medicare Advantage Appeals & Grievances experience

Project management

Exceptional communication

Attention to detail

Analytical problem-solving

Formação académica

Bachelor's degree in healthcare, law, or related field

Descrição da oferta de emprego

Employer Industry: Healthcare Services

Why Consider This Job Opportunity

• Base salary range up to $103,732 per year
• Opportunity for an annual employee bonus program
• Generous paid time off (PTO) and eleven paid holidays per year, plus additional floating and birthday holidays
• Robust employee recognition program and tuition reimbursement
• Work mode is mostly remote, offering flexibility in your work environment
• Join a mission-driven organization that makes a difference in the lives of older adults

Job Responsibilities

• Conduct regular monitoring of grievance and appeal processes to ensure compliance with regulations and internal policies
• Identify and document discrepancies in grievance and appeal processes, working with teams to address issues
• Provide constructive feedback and facilitate continuous improvement within the grievance and appeal review team
• Perform root cause analysis to identify errors and recommend preventive strategies
• Maintain accurate records of audit activities, findings, and corrective actions taken

Qualifications

• At least 5 years of experience in Medicare Advantage Appeals & Grievances or a closely related field
• Bachelor's degree or equivalent experience in healthcare, law, or a related field
• Strong project management experience with the ability to manage multiple projects in a fast-paced environment
• Exceptional communication skills, both oral and written, with strong interpersonal abilities
• Attention to detail, critical thinking, and analytical problem-solving skills

Preferred Qualifications

• Experience in a regulatory or compliance role within the healthcare sector
• Familiarity with Medicare Advantage regulations and internal compliance standards
• Demonstrated ability to work collaboratively across departments to drive improvements

We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.