Senior Grievances & Appeals Analyst

Responsibilities Analyze and audit complaints received by the plan to ensure the integrity of claims, authorization processes, and business operations. Utilize established process guidelines and industry knowledge to validate organizational decisions and assess downstream and upstream impacts. Perform root cause analysis of audit findings and make recommendations for appropriate change management. Emphasize continuous improvement by identifying opportunities to reduce redeterminations, complaints, and rework of claims. Identify trends and areas of improvement resulting from information obtained through the Resolution team resources and available reporting/data. Requirements 5 or more years of healthcare services experience in Sales, enrollment, Complaints to Medicare (CTMs) 1 or more years auditing experience Experience using data analysis tools (such as Excel, SQL, or Power Bi) to create and analyze reports to identify trends Demonstrated knowledge using advanced features in Microsoft Excel, including data sorting, pivot tables, and complex formulas. Experience managing concurrent projects, maintaining thoroughly documented outcomes and minimal data entry error rates. #J-18808-Ljbffr Jobtailor