Requirements: English
Company: AF Group
Region: Southborough, Estados Unidos
The Appeals and Grievances Analyst is accountable for processing grievances and appeals in the highest quality possible and for ensuring that Grievances and Appeals are performed timely, and accurately.The Appeals and Grievances Analyst will partner with other Analysts and with the Grievance and Appeals Manager to ensure accuracy of data and timeliness of processes.**What you will do**:- Follows Grievances and Appeals processes and systems to ensure data quality to support ikaSystems'' quality, production and financial goals- Investigate and thoroughly document findings on all grievances and appeals- Drive operational excellence into all processes and departmental interactions based on CMS and ikaSystems requirements- Bring to management''s attention any system or process issues determined during the investigation of the grievance or appeal- Coordinate effectively with the Information technology department on upgrades/fixes/changes- Participate in the departmental audit/oversight program that focuses on continuous quality improvement- Other duties as assigned**What you will need**:- Bachelor''s degree or equivalent work experience; background in insurance or managed care preferably in a Grievance and Appeals or Customer Service department- Proven problem solving skills and ability to translate knowledge to corporate departments- Experience with the Grievance and Appeals regulations per CMS- Strong attention to detail- Demonstrated track record of generating results and having an impact on organizations- Ability to work in a high paced environment- Experience with Microsoft Office suite of products and strong computer skillsTransforming healthcare, together.ikaSystems is a premier provider of enterprise, cloud-based business process and automation solutions for healthcare payers and an independent subsidiary of Blue Cross Blue Shield of Michigan. Our business software solutions deliver advanced business technology to health plans within the commercial, Medicare, Medicaid, Exchange, and ACO business.At ikaSystems, we believe the foundation of our success lies in our core values: value for our customers, accountability, integrity, innovation, and teamwork. We offer a competitive compensation and benefits package including Medical, Dental, Life & Disability, paid time off, and 401k with matching employer contribution.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or national origin.Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled