Member Appeal Analyst

Spectrum Health
Any Location, MI
Category Customer Service
Job Description
Responsible for analyzing, researching and completing complex member appeal investigations. Effectively administer all steps of the member appeal and fair hearing processes to thoroughly investigate appeal requests, leveraging critical thinking skills and collaboration to resolve issues. Ensure compliance with all mandated, legislative, regulatory and accreditation requirements.

Requirements

  • Associate's degree or equivalent
  • 2 years of relevant experience in Member of Provider Customer Service, claims, Legal and/or enrollment/eligibility
  • Working knowledge of Priority Health systems for claims payment, care management, authorizations, customer service interactions, pharmacy Rx profiles, medical policies and plan documents for Medicare product lines (preferred)
  • Extensive knowledge of managed care products and regulatory and accreditation requirements (preferred)
  • Intermediate or advanced level using Microsoft Office Suite

Benefits

  • Comprehensive benefits package
  • On-demand pay program
  • Discounts directory
  • Optional identity theft protection
  • Home and auto insurance
  • Pet insurance
  • Traditional and Roth retirement options
]]>