Medicare Appeals Analyst

This is a Fully Remote Job
About Our Client:
The organization operates within the health insurance industry, addressing challenges related to managing appeals and grievances for commercial and Medicare health plans. It focuses on maintaining compliance with federal and state regulations and improving operational efficiency in its departments. The company offers comprehensive benefits and is recognized as a favorable workplace, reflecting its commitment to employee and community well-being.
About the Opportunity:
The MEDICARE APPEALS ANALYST role is designed to provide analytical problem-solving support to appeals and grievances staff, primarily focusing on commercial and Medicare cases. The position acts as a central liaison both internally and externally, ensuring regulatory compliance and contributing to process improvements. This role significantly impacts the effectiveness and timeliness of appeals processing, supporting the organization's commitment to regulatory adherence and operational excellence.
Responsibilities:
Lead departmental process improvements and represent the department in inter-departmental projects and system enhancements.
Respond to inquiries and issues from appeals staff, other departments, and external partners.
Assist in researching, evaluating, and developing policies and procedures to improve processing effectiveness.
Serve as the subject matter expert on appeals module configuration and customer service inquiry interactions within the Facets system.
Support compliance activities related to federal and state regulations for Medicare and commercial operations.
Provide research support to resolve trends and specialty inquiries as requested by management.
Conduct peer reviews, audit support, desk mentoring, and functional training for staff.
Evaluate performance metrics and communication materials to determine departmental impact.
Assist with training programs and collaborate with training staff and management.
Promote and reinforce company policies and provide technical support for relevant systems and software.
Requirements:
In-depth understanding of health insurance benefit programs, including Medicare and Commercial.
Proficiency with PC software, especially Microsoft Office Suite.
Strong oral and written communication skills suitable for diverse audiences.
Ability to work independently and collaboratively, prioritizing tasks effectively.
Competency with Windows applications and experience navigating the Facets system.
Technical understanding of configuration and business requirements in support of appeals processing.
Pay Range and Compensation Package:
The pay range and compensation package for this role will be determined based on the candidate's experience, skills, and other relevant factors.
Benefits & Perks:
Medical, Dental, and Vision coverage
Retirement plan
Paid time off including holidays and volunteer time
Incentive plan
Tuition reimbursement
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.

Work arrangement
Yes