Appeals and Grievances Quality Analyst- Kelsey Seybold - Remote in TX or LA
$20.38/h-$36.44/h
Optum3 days ago
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RemoteFull-timeMid
Summary
Optum is seeking an Appeals and Grievances Quality Analyst to join their team remotely in TX or LA. The role involves leading quality reviews for the KelseyCare Advantage Operations Department, focusing on Appeals & Grievances, Enrollment, and Regulatory Teams.
About the Role
As an Appeals and Grievances Quality Analyst, you will be responsible for analyzing eligibility data, reviewing CMS transaction reports, and optimizing workflows. You will monitor appeals and grievances for timeliness and accuracy, ensure documentation consistency, and train new coordinators. The role includes handling complex cases, aiding in CMS audits, and recommending process improvements.
About You
Required:
- High School diploma or equivalent.
- 3+ years of experience with Healthcare Appeals and Grievances.
- 2+ years of Medicare Advantage experience.
- Knowledge of CMS Regulations including Appeals and Grievances, Enrollment, and Member Services.
- Demonstrated analytical skills including file format manipulation and data comparison.
Preferred:
- Epic Managed Care experience.
- Experience in Health Plan Operations in Healthcare Industry.
- Knowledge of CMS Audits.
- Proven ability to analyze and report on appeals and grievance trends and quality error rates.
Benefits
- Comprehensive benefits package including medical, dental, and vision coverage.
- Incentive and recognition programs.
- Equity stock purchase and 401k contribution.
Optum
We’re evolving health care so everyone can have the opportunity to live their healthiest life. It’s why we put your unique needs at the heart of everything we do, making it easy and affordable to manage health and well-being. We are delivering the right care how and when it’s needed; providing support to make smarter and healthier choices; and making prescription services easier, while helping you save money along the way. It’s everything health care should be. Together, for better health. Optum is part of UnitedHealth Group (NYSE: UNH).
Pearland, TX