Appeals Analyst — Regulatory & Policy Insights

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

Job summary

Wellfleet is seeking an experienced Appeals Analyst to support the Legal team. This role focuses on timely review of all appeals and complaints across product lines, ensuring adherence to policy language and regulatory timeframes.

The ideal candidate will have an associate degree and 3+ years of relevant experience, strong writing and communication skills, and solid knowledge of state regulations and medical coding terminology.

Qualifications

• Associate’s Degree and 3+ years relevant work experience or equivalent combination of education and experience.
• Detail oriented with strong communication skills.
• Strong organizational skills, including thorough and complete follow-up to all time-sensitive items.
• Excellent written and verbal communication skills.
• Excellent interpersonal skills. Commitment to a team-oriented office environment.
• Internet savvy and proficient with Microsoft Word, Outlook, and Excel.
• Ability to interpret policy language.
• Demonstrated business writing proficiency in accordance with regulatory requirements, internal policies, and claim events.
• Strong aptitude and familiarity with medical coding and medical terminology.
• Strong understanding and familiarity of the different state regulations.
• Must demonstrate excellent written communication skills
• Detail oriented problem solver with good time management skills.

Responsibilities

• Analyze and respond to appeals and Department of Insurance complaints in accordance with policy language and regulatory requirements.
• Prepare and send acknowledgements and correspondence within deadlines.
• Gather, review, and maintain documentation to support appeal and complaint responses.
• Conduct research and analysis using approved guidelines and tools.
• Monitor requirements with Compliance and other departments and support process improvements.
• Follow up on inquiries, requests, and tasks through to completion.
• Maintain knowledge of products, systems, and workflows including LuminX, Spartacus, and Microsoft Office.
• Communicate with carriers and internal departments as needed, including escalated appeal inquiries.
• Follow management-approved workflows and make independent decisions based on available data.
• Manage multiple priorities and meet deadlines.
• Provide back-up support to the Appeals Manager including reporting requests and staff onboarding.

Skills

Associate degree

3+ years experience

Detail oriented

Strong communication

Policy language interpretation

Medical coding terminology

State regulations familiarity

Time management

Business writing proficiency

Education

Associate's Degree

Tools

LuminX

Spartacus

Microsoft Office

Job description

Wellfleet is seeking an experienced Appeals Analyst to support the Legal team. This role focuses on timely review of all appeals and complaints across product lines, ensuring adherence to policy language and regulatory timeframes.

The ideal candidate will have an associate degree and 3+ years of relevant experience, strong writing and communication skills, and solid knowledge of state regulations and medical coding terminology.