Medicare Grievances & Appeals Analyst

Solis-Health-Plans; Florida; On-site; USD 55,000 - 75,000; Full time

Job summary

Solis-Health-Plans in Doral, FL is seeking a Grievance and Appeals CTM Analyst to review, investigate, track, and resolve member complaints under CMS CTM requirements. You will collaborate with internal teams, delegated entities, providers, and stakeholders to ensure timely, compliant responses while maintaining confidentiality of protected health information.

This role emphasizes attention to detail, regulatory knowledge, and strong communication to improve member experience and regulatory

Qualifications

• High school diploma or equivalent required; degree preferred in healthcare or related field.
• Experience with Medicare Advantage, health insurance, or grievances and appeals preferred.
• Familiarity with CMS requirements and health plan operations is a plus.
• Strong analytical, organizational, and problem-solving abilities with attention to detail.

Responsibilities

• Review and investigate member complaints through CMS CTM and other channels.
• Analyze records to determine facts and appropriate resolutions within timelines.
• Coordinate with internal departments and delegated entities to gather information.
• Identify potential compliance, service, or benefit issues and document findings.
• Monitor progress to ensure adherence to CMS and internal turnaround times.
• Escalate complex or non-compliant cases to management as needed.
• Assist with complaint reporting, audits, and regulatory inquiries.

Skills

Analytical thinking

Organizational skills

Problem solving

Communication skills

Attention to detail

Policy interpretation

Education

HS diploma

AA/BA preferred

Tools

MS Office

CMS/case-management systems

Job description

Solis-Health-Plans in Doral, FL is seeking a Grievance and Appeals CTM Analyst to review, investigate, track, and resolve member complaints under CMS CTM requirements. You will collaborate with internal teams, delegated entities, providers, and stakeholders to ensure timely, compliant responses while maintaining confidentiality of protected health information.

This role emphasizes attention to detail, regulatory knowledge, and strong communication to improve member experience and regulatory