Quality Analyst - Grievance and Appeals - Remote

Overview

The Quality Analyst applies in-depth knowledge of subject matter and independently coaches others on matters regarding complaints and appeals, ensuring compliance with federal and/or state regulations.

In Short

• Participates in external and internal audits.
• Analyzes quality and completeness of complaints and appeals documentation.
• Recommends process changes for complaints and appeals.
• Assists in analyzing patterns and trends.
• Compiles reports on quality metrics.
• Facilitates inquiries and maintains a customer-centric approach.
• Gathers documentation for compliance audits.
• Acts as a liaison between the organization and relevant individuals.
• Receives and implements feedback for service delivery.
• Ensures compliance with federal and state regulations.

Requirements

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

Benefits

• Affordable medical plan options.
• 401(k) plan with company matching.
• No-cost wellness programs.
• Flexible work schedules.
• Tuition assistance.
• Comprehensive pay and benefits mix.