Remote Appeals Analyst – Health Plan Complaints

Blue Cross and Blue Shield of Kansas City; Kansas City (MO); Hybride; USD 65 000 - 90 000; Plein temps

Avantages offerts par ce poste

Competitive benefits package

401(k) with employer match

Paid holidays and time off

Volunteer time off

Tuition reimbursement

Parental leave and adoption leave with

Employee discount program

Résumé du poste

Blue Cross and Blue Shield of Kansas City is seeking an Appeals Analyst to review and resolve member and provider complaints, grievances, and appeals. This role may work from home with management approval based on business needs and performance.

Responsibilities include gathering information, documenting SOP-based processes, and communicating follow-up actions to ensure timely resolutions while adhering to federal, state, and BCBS standards.

Qualifications

• Bachelor's degree or 4 years of relevant health insurance experience.
• 1–3 years researching and responding to customer claim/benefit issues.
• Ability to communicate with members, providers, and management about complaints/appeals.
• Strong written communication of complex processes and decisions.
• Working knowledge of health benefit certificates and major BCBSKC lines.

Responsabilités

• Gather and review information to determine resolution of complaints, grievances, and appeals.
• Document work according to SOPs so outcomes are reproducible.
• Develop timely, accurate responses to complaints and appeals per SOPs and accrediting requirements.
• Communicate follow-up actions to operational areas and ensure timely completion.

Formation

Bachelor's degree in business, finance, accounting, law, health care administration, or other relevant academic discipline

Description du poste

Blue Cross and Blue Shield of Kansas City is seeking an Appeals Analyst to review and resolve member and provider complaints, grievances, and appeals. This role may work from home with management approval based on business needs and performance.

Responsibilities include gathering information, documenting SOP-based processes, and communicating follow-up actions to ensure timely resolutions while adhering to federal, state, and BCBS standards.