Appeals Analyst

Freddie Mac; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company is seeking an Appeals Analyst to review and respond to appeals and inquiries regarding adverse benefit determinations. The role requires independent judgment and knowledge of insurance products, with responsibilities including analyzing inquiries and maintaining case records. Ideal candidates will have strong communication skills and a background in healthcare grievances or claims processing.

Qualifications

• Minimum three years' experience in healthcare grievances or related legal areas.
• Knowledge of insurance products and claims processing preferred.

Responsibilities

• Analyze and respond to inquiries and complaints from members and providers.
• Prepare written analysis and monitor appeal statuses.
• Recommend process improvements to reduce legal risks.

Skills

Organizing work independently

Decision making

Dependability

Business writing

Medical knowledge

Workload management

Presentation skills

Effective communication

Education

Bachelor's degree in a related field

Tools

Microsoft Office

Job description

Job Description: Appeals Analyst

To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here.

Applicants must be eligible to begin work on the date of hire. Applicants must be currently authorized to work in the United States on a full-time basis. Arkansas Blue Cross Blue Shield will NOT sponsor applicants for work visas for this position.

Arkansas Blue Cross is only seeking applicants for remote positions from the following states:

Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.

Workforce Scheduling

Job Summary

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 exercise independent judgment to determine whether an adverse benefit determination was legal, appropriate, impartial, and in accordance with the enterprise's obligations under the applicable contract.

Minimum Requirements

Education

Bachelor's degree in a related field. In lieu of degree, five (5) years' relevant experience will be considered.

Experience

Minimum three (3) years' experience in healthcare grievances, appeals, claims processing, claims research, customer service, or related legal areas. Knowledge of insurance products, policies, procedures, and claims processing is preferred. Experience with Microsoft Office (Word and Excel) is required.

Skills & Abilities

• Organizing work independently
• Decision making and sound judgment
• Dependability and confidentiality (HIPAA and legal)
• Business writing and taking initiatives
• Medical knowledge and English grammar
• Workload and time management
• Presentation skills and effective communication

Responsibilities

Analyze and respond to inquiries, complaints, and concerns from members, providers, and regulatory bodies. Prepare written analysis and monitor appeal statuses. Communicate policy and processing guidelines effectively. Maintain case records, stay updated on benefit plans, and perform other duties as assigned. Recommend process and contract improvements to reduce legal and regulatory risks. Utilize current medical coding standards (CMS, CPT, ICD-10) to ensure clarity in appeals.

Certifications and Security

This position is classified as level three (3). It requires ensuring the confidentiality and security of records and information, following company policies outlined in the Administrative Manual. Adherence to segregation of duties guidelines is mandatory.

Employment Details

Type: Regular

ADA Requirements

Position involves sedentary work, primarily in an office or remote setting, with routine travel within walking distance of the primary work location.