W3R Consulting · 13 hours ago
Appeals/Claims analyst
Detroit, MI
Contract
Remote
Entry Level
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Responsibilities
Review, analyze, and process appeals and grievances, ensuring compliance with regulatory and accreditation guidelines.
Conduct in-depth research to evaluate cases and provide comprehensive responses.
Collaborate with customers to gather necessary information and effectively communicate case outcomes.
Utilize your expertise to interpret contracts, state and federal regulations, and health insurance policies.
Work efficiently in a high-volume environment, balancing multiple tasks and deadlines.
Qualification
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Required
Proven ability to manage a high workload in a fast-paced environment, with strong computer proficiency.
Knowledge of insurance, Medicare, and CMS regulations.
Outstanding customer service experience with a customer-first mindset.
Exceptional letter-writing and communication skills.
Analytical thinking and problem-solving abilities.
Strong research skills to evaluate and resolve complex cases.
Multitasking skills to handle multiple priorities seamlessly.
Bachelor’s Degree (Required)
Preferred
Grievance and Appeals experience.
Bachelor's degree in Healthcare or related field.
Familiarity with claim analysis and differentiating between grievance, appeal, and organizational determination.
Proficiency in saving PDFs, navigating Excel, and quickly learning new systems.
Benefits
Work remotely from the comfort of your home.
Contribute to improving the healthcare experience for customers.
Be part of a dynamic, customer-focused team in a thriving industry.
Build on your expertise in health insurance regulations, project management, and case analysis.
Company
W3R Consulting
W3R Consulting is an information technology company that provides advanced analytics and program management services.
Founded in 1995
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
E
Eric Hardy
President and CEO
Company data provided by crunchbase
