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Complaint Appeal Analyst Jobs (NOW HIRING)

BrightonOne

Director, Customer Experience

Brighton, MA · Hybrid

$130K - $150K/yr

... grievances, appeals, member and provider pain points, and complaint trends; identify systemic ... Executes projects and initiates joint problem-solving using data analysis tools, performance ...

BrightonONE

Director, Customer Experience

Brighton, MA · On-site

$130K - $150K/yr

... grievances, appeals, member and provider pain points, and complaint trends; identify systemic ... Executes projects and initiates joint problem-solving using data analysis tools, performance ...

Socket.dev

Director, Customer Experience

Boston, MA · On-site

$180 - $230/hr

... grievances, appeals, member and provider pain points, and complaint trends; identify systemic ... Executes projects and initiates joint problem-solving using data analysis tools, performance ...

UCLA Health

Employee Relations Investigator

Los Angeles, CA · On-site

$105K - $234K/yr

You will assist in process improvements related to complaint investigations; within Human Resources ... DOL, EEOC, Title IX, FMLA/CFRA, ADA, etc). • Strong analytical skills to interpret and dissect ...

Direct Counsel

Contract Attorney

San Francisco, CA · Hybrid

$45.50/hr

... for complaint matters * Assist with investigative documentation and analysis Required ... Experience drafting motions and/or appellate briefs * Experience writing legal memoranda (court ...

Direct Counsel

Contract Attorney

Los Angeles, CA · Hybrid

$45.50/hr

... for complaint matters * Assist with investigative documentation and analysis Required ... Experience drafting motions and/or appellate briefs * Experience writing legal memoranda (court ...

SafeRide Health

Complaints and Grievance Supervisor

San Antonio, TX · On-site +1

$102K - $123K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... complaint, grievance, appeal, and dispute case management, ensuring proper documentation and ... Analyze trends in complaints and grievances, providing insights and recommendations to leadership ...

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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.

More about Complaint Appeal Analyst jobs

What job categories do people searching Complaint Appeal Analyst jobs look for?

The top searched job categories for Complaint Appeal Analyst jobs are:

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.

Complaints and Grievance Coordinator

SafeRide Health

San Antonio, TX

$16.50 - $21.50/hr

Full-time

Medical

Posted 13 days ago

Job description

Job Summary:

SafeRide Health is seeking an experienced Complaints and Grievance Coordinator responsible for processing complaints and grievances, consisting of member grievances, appeals, and provider disputes. This role ensures that cases are resolved by client-specific requirements across all lines of business.


Primary Responsibilities

  • Maintain contractual compliance and customer satisfaction
  • Ensure that all assigned complaints and grievances are completed by the deadline and other contractual requirements
  • Respond to Comment Letters and client inquiries and requests
  • Ensure interactions remain positive and professional with all persons with whom you and the Complaints and Grievance Team interact in the course of your work, both internally and externally
  • Researching the details and history of a case and creating a clear timeline of events
  • Communicating, both orally and in writing, with members and providers as needed
  • Updating members and providers regarding the progress of active and open cases
  • Requesting, reviewing, sorting, and preparing data related to complaints and grievances
  • Working with relevant departments to complete all necessary follow-up and research
  • Complaint and grievance escalations
  • Interdepartmental and Client Communication
    • Provide daily, weekly and monthly complaint and grievance updates to leadership
    • Recommend solutions and work with internal department leadership to ensure problems are corrected, and departments are advised of corrective measures to prevent recurrences
    • Provide complaint and grievance data to leadership regarding provider complaint and grievance trends
  • Other duties as assigned


Required Education and Experience:

  • Minimum High school diploma or equivalent
  • Minimum one (1) year in grievance and appeals processing
  • Minimum one (1) year in an inbound call center environment


Preferred Education and Experience

  • Experience with Medicaid, Medicare, and NEMT guidelines
    • Associate's degree in relevant discipline
    • Knowledge of health insurance programs and benefits


    Skills

    • Customer-oriented with the ability to address customers' needs while following company procedures.
    • Outstanding problem-solving skills and ability to use soft skills in a high-stress environment
    • Strong analytical skills and the ability to use thinking and logic to solve everyday issues
    • Personable, with solid leadership and mentoring skills
    • Strong communication skills (both verbal and written) and demonstrated ability to communicate, present, and influence effectively in person, via email, and over the phone
    • Ability to meet contractual reporting requirements and deadlines
    • Ability to adapt to unforeseen circumstances quickly
    • Ability to respond to sensitive or complex issues with tact and sensitivity
    • Proficiency in listening and problem-solving skills
    • Ability to establish and maintain effective working relationships with members, coworkers, providers, and individuals of varying socio-economic and cultural backgrounds and with special needs populations
    • Ability to effectively, clearly, and independently document, summarize and resolve member's concerns and inquiries


    About Us:

    SafeRide Health is a technology and services company dedicated to reducing barriers to care by improving the delivery of non-emergency medical transportation to people across America. SafeRide Health leverages proprietary technology and a nationwide network of vetted transportation providers to give payers and health systems a more intelligent way to deliver cost-effective, on-demand transportation while improving the patient experience. SafeRide serves the largest Medicare Advantage, Medicaid, and provider programs in the country. Learn more atwww.saferidehealth.com.

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