Appeals Analyst — Health Insurance Compliance

Wellfleet Group; Springfield (MA); On-site; USD 52,000 - 58,000; Full time

Benefits offered by this job

Competitive pay

Benefits package

401K plan

Tuition reimbursement

Job summary

Wellfleet, a Berkshire Hathaway company, seeks an experienced Appeals Analyst to support the Legal team. You will review all Appeals and Complaints across product lines and ensure timely responses in accordance with policy language and regulatory timeframes.

The role requires attention to detail, strong communication, and knowledge of medical coding, COB, ACA, HIPAA Privacy, and claims payment rules. You will collaborate with Compliance and other departments and maintain documentation in systems

Qualifications

• Assocaite’s Degree required; 3+ years relevant work experience preferred.
• Detail oriented with strong communication skills.
• Excellent written and verbal communication abilities.
• Proficiency with medical coding and medical terminology.
• Solid understanding of state regulations.
• Ability to interpret policy language.

Responsibilities

• Analyze and respond to appeals and Department of Insurance complaints within policy language and regulatory timeframes.
• Prepare acknowledgements and correspondence within deadlines.
• Gather and maintain documentation to support appeal and complaint responses.
• Conduct research with approved guidelines and regulatory requirements.
• Collaborate with Compliance and other departments on trends and process improvements.
• Maintain knowledge of products, systems, and workflows (LuminX, Spartacus, MS Office).
• Communicate with carriers and internal departments as needed; escalate inquiries.
• Follow approved workflows and make independent decisions based on research.

Skills

Attention to detail

Communication skills

Organizational skills

Time management

Medical coding familiarity

Interpersonal skills

Education

Associate’s Degree

Tools

Microsoft Word

Outlook

Excel

Job description

Wellfleet, a Berkshire Hathaway company, seeks an experienced Appeals Analyst to support the Legal team. You will review all Appeals and Complaints across product lines and ensure timely responses in accordance with policy language and regulatory timeframes.

The role requires attention to detail, strong communication, and knowledge of medical coding, COB, ACA, HIPAA Privacy, and claims payment rules. You will collaborate with Compliance and other departments and maintain documentation in systems