Remote Appeals Analyst - Health Plan Grievances

Blue Cross and Blue Shield of Kansas City; United States; Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Bonus plan

Paid time off

Volunteer time off

Tuition reimbursement

Professional development

Mentorship

Parental leave

Adoption assistance

Employee discounts

Job summary

Blue Cross and Blue Shield of Kansas City is seeking an Appeals Analyst to manage complaints, grievances and appeals. You will gather information, document findings, and craft timely responses in line with policy and regulatory requirements.

Remote work is possible with management approval based on business needs and performance. The role requires understanding of member health benefits, BCBSKC lines of business, and related SOPs to ensure accurate resolutions and clear communication with

Qualifications

• Bachelor’s degree in business, finance, accounting, law, health care administration or equivalent experience.
• 1-3 years of experience at a health insurer researching and responding to customer claim / benefit issues.
• Ability to communicate with a broad range of individuals including members, providers and senior management on issues related to complaints, grievances or appeals.
• Ability to compose professional business correspondence, including communication of complex processes and decisions.
• Working knowledge of member health benefit certificates.
• Thorough knowledge of BCBSKC lines of business, systems and operational processes.
• Working knowledge of BCBSKC medical policies.
• Understanding of federal/state and accrediting body requirements related to complaints, grievances and appeals.
• Thorough knowledge of BCBSKC member health benefits certificates.

Responsibilities

• Gather and review information necessary to determine appropriate resolution of complaints, grievances and appeals.
• Document work according to SOPs so others reach the same conclusion.
• Develop timely, accurate responses to complaints, grievances and appeals, complying with all guidelines.
• Communicate follow up actions to operational areas and ensure timely completion.

Skills

Complaint handling

Customer service

Written communication

Policy knowledge

SOP knowledge

Education

Bachelor’s degree in business, finance, accounting, law, health care administration

Job description

Blue Cross and Blue Shield of Kansas City is seeking an Appeals Analyst to manage complaints, grievances and appeals. You will gather information, document findings, and craft timely responses in line with policy and regulatory requirements.

Remote work is possible with management approval based on business needs and performance. The role requires understanding of member health benefits, BCBSKC lines of business, and related SOPs to ensure accurate resolutions and clear communication with