Inquiries, Appeals, and Dispute Analyst - Remote

Overview

The Inquiries, Appeals, and Dispute Analyst role involves investigating referral and authorization episodes to determine approval or denial of claims, responding to inquiries from Home Plans, and resolving disputes.

In Short

• Review and finalize claims reports.
• Respond to email inquiries from Home Plans.
• Work on reconciliations of members' out-of-pocket maximums.
• Investigate claim appeals and disputes.
• Prepare responses to appeals outlining findings.
• Identify root causes of denials.
• Communicate resolutions to stakeholders.
• Respond to Blue Cross appeals.
• Gather documentation for inquiries.
• Escalate complex inquiries as needed.

Requirements

• 2-5 years of claims processing experience.
• Knowledge of CPT and ICD coding.
• Ability to read benefit plan descriptions.
• Strong independent work and task prioritization skills.
• Understanding of coding requirements and medical terminology.
• Intermediate to advanced Microsoft Office skills.
• Problem-solving and initiative.
• Knowledge of claims processing compliance.
• Effective communication skills.
• Ability to work with minimal supervision.

Benefits

• Fully remote work environment.
• Comprehensive Medical, Dental, and Vision plans.
• 401(k) plan with employer match.
• Life and Disability insurance options.
• Employee Assistance Program (EAP).
• Flexible Time Off policies.
• Paid parental leave.
• Resources for professional growth and development.