Grievance and Appeals Quality Analyst - Remote

Overview

This position involves applying in-depth knowledge of complaints and appeals to ensure compliance with federal and state regulations, while contributing to quality improvement initiatives.

In Short

• Fully remote position.
• 1+ years of compliance and external audit experience required.
• Responsible for analyzing quality and completeness of complaints and appeals documentation.
• Contributes to process improvements and recommends training programs.
• Compiles reports on quality metrics to enhance service delivery.
• Facilitates inquiries and maintains a customer-centric approach.
• Assists in compliance audits and gathers necessary documentation.
• Acts as a liaison between the organization and relevant individuals.
• Full-time position with anticipated weekly hours of 40.
• Competitive pay range and comprehensive benefits offered.

Requirements

• 1+ years of Compliance experience.
• 1+ years of External Audit Experience.
• 1+ years of Grievance and Appeals Experience.
• Experience with Medicare and/or Medicaid.
• High School Diploma or GED required.

Benefits

• Affordable medical plan options.
• 401(k) plan with company matching.
• No-cost wellness programs and counseling.
• Flexible work schedules and paid time off.
• Tuition assistance and retiree medical access.