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Complaint Appeal Analyst Jobs (NOW HIRING)

Independent Health Association

$22.50 - $27.50/hr

Ability to analyze problems systematically, organize information, identify underlying causes and ... Information gathered in appeal/complaint activity is relied upon for internal and external ...

Independent Health

Contractual Reviewer-Senior

Buffalo, NY · On-site

$22.50 - $27.50/hr

Ability to analyze problems systematically, organize information, identify underlying causes and ... Information gathered in appeal/complaint activity is relied upon for internal and external ...

Curana Health, Inc.

Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and ... Prepare all appeal and grievance-related correspondence, including acknowledgment letters ...

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Complaint Appeal Analyst information

What is a complaint appeal analyst?

A Complaint Appeal Analyst is a professional who reviews and investigates complaints and appeals, typically within the healthcare or insurance industries. Their main responsibility is to ensure that all grievances and appeals are handled according to company policies, regulatory requirements, and industry standards. They analyze case documentation, communicate with involved parties, and make recommendations or decisions regarding the resolution of cases. This role requires strong analytical, communication, and problem-solving skills, as well as a thorough understanding of relevant laws and regulations.

How does a complaint appeal analyst typically interact with other departments to resolve complex cases?

Complaint Appeal Analysts frequently collaborate with departments such as Customer Service, Legal, Compliance, and Clinical teams to gather relevant information, clarify policies, and ensure all aspects of a case are reviewed. This cross-functional teamwork is essential for accurately assessing appeals and making fair determinations. Analysts often coordinate meetings, request documentation, and communicate findings, so strong interpersonal and communication skills are key to success in this role.

What are the key skills and qualifications needed to thrive as a complaint appeal analyst, and why are they important?

To thrive as a Complaint Appeal Analyst, you need strong analytical abilities, attention to detail, and a solid understanding of healthcare regulations or insurance guidelines, often supported by a bachelor’s degree in a related field. Familiarity with case management systems, claims processing software, and regulatory databases is typically required. Excellent written communication, problem-solving skills, and the ability to handle sensitive situations with professionalism set top candidates apart. These skills are essential for ensuring compliance, resolving complex appeals efficiently, and maintaining trust between clients and organizations.

What is the difference between Complaint Appeal Analyst vs Customer Service Representative?

AspectComplaint Appeal AnalystCustomer Service Representative
Primary RoleInvestigates and resolves complaint appeals, ensuring compliance and fairnessAssists customers with inquiries, provides information, and resolves general issues
Required SkillsAnalytical skills, knowledge of policies, communication skillsCommunication, problem-solving, customer service skills
Work EnvironmentOffice setting, often in compliance or quality assurance departmentsCall centers, retail, or service environments
Common CertificationsCustomer service certifications, compliance trainingCustomer service certifications, basic computer skills

The Complaint Appeal Analyst focuses on reviewing and resolving complex complaint appeals, often requiring analytical skills and compliance knowledge. In contrast, Customer Service Representatives handle general customer inquiries and support. While both roles involve communication and customer interaction, the Complaint Appeal Analyst's work is more specialized and compliance-driven, whereas the Customer Service Representative's role is broader and service-oriented.

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Complaint Appeal Analyst jobs near you
Infographic showing various Complaint Appeal Analyst job openings in the United States as of August 2026, with employment types broken down into 89% Full Time, 5% Part Time, and 6% Contract. Highlights an 80% Physical, 9% Hybrid, and 11% Remote job distribution.

Complaint Analysts/ Complaint Specialist/ Complaint

Integrated Resources INC

Raritan, NJ • On-site

Contractor

Re-posted 16 days ago

Job description

Company Description

A Few Words About Us
Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Description

Complaint Analysts/ Complaint Specialist/ Complaint coordinator is the frequent open position in Johnson & Johnson. Please share below the details and your updated resume with us so that I would be able to submit you first compare to other candidates in order to get the in -personal interview request from the company.

I would like to mention that Johnson & Johnson has fastest interview process, as per our multiple year of experience, they moves very fast with the in - personal and offer. We have placed so many candidates, those we have submitted in an hours when the position comes in.

Take some smart step and get the job in one of the leading healthcare company - Johnson & Johnson.

Please provide the below details

Total Experience -

Expected Rate -

Current Rate -

Visa Status -

DOB( Just Date and month is require for submission purpose ) -

Available for in person -

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In considering candidates, time is of essence so please respond ASAP. 


Additional Information

Contact- Tel: (732) 549 2030 x 210

Sweta Verma 


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About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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