Appeal Analyst

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Arkansas Blue Cross and Blue Shield

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1948

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Arkansas Blue Cross and Blue Shield is a health insurance provider licensed to offer health plans in all 75 counties of Arkansas. The company offers a wide range of insurance products including individual and family plans, Medicare and Medigap plans, dental and vision plans, as well as health plans for travelers and employer group plans. They provide members with personalized services such as health management through the Blueprint Portal, where users can manage their health plan, review claims, find healthcare providers, and estimate treatment costs. Arkansas Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association.

📋 Description

• Analyze and respond to inquiries, complaints and/or concerns from members, providers, regulatory bodies and/or attorneys • Communicate medical coverage policy, processing guidelines and policy language with internal and external sources to facilitate, resolve, and respond to appeals within URAC/legal timeframe • Maintain administrative records of all case files, log appeals, and request relevant information from internal and external sources • Maintain thorough knowledge of benefit plans • Monitor the status of appeals • Prepare written analysis communicating facts and determinations for appeal responses within the timeframe • Recommend changes to the appeals process and contract language to minimize legal and regulatory liability • Utilize current information from medical coding sources to ensure appeal guidelines are clear and concise • Perform other duties as assigned

🎯 Requirements

• Bachelor’s degree in related field, or five (5) years' relevant experience in lieu of degree in addition to the listed experience requirements • Minimum three (3) years' healthcare grievances, appeals, claims processing, claims research, customer service or related legal experience • Working knowledge of insurance products, policies, procedures and/or claims processing preferred • Experience using Microsoft Office, including Word and Excel • Sound Judgement • HIPAA Confidentiality • Legal Confidentiality • Taking Initiative • Security and confidentiality of records and information • Adherence to segregation of duties guidelines