We are representing a new opportunity with one of our top clients. This is a great chance to work for a diversified company in the Pharmaceutical industry.
The ideal candidate will have a Bachelor's Degree or Associates degree OR previous data auditing / entry experience -- and will be comfortable working in a fast-paced, detail oriented, analytical environment.
This is a great opportunity to join a well-established corporate team where you will have the opportunity to make an impact and start on a dynamic and strong carer path.
- Reviews, analyzes and processes appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable language
- Ensure data quality and completeness of all records matched, added, or updated through adherence to established validation methods and standards.
- Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and records to either approve or summarize and route to staff for review.
- The grievance and appeal work is subject to applicable accreditation and regulatory standards and requirements.
- As such, the analyst will strictly follow department guidelines and tools to conduct their reviews.
- Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.
- The analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments.
- Previous work experience or internship experience handling data, analysis or processing a plus
- Advanced web research abilities
- Entry level candidates with no experience will be considered - indepth training provided
- Demonstrate excelled written and verbal communication skills
- Comfortable with limited phone research
- Strong organizational skills with the ability to multi-take under pressure