[Hiring] Appeals & Grievances Analyst @The Harbor Health Team

Role Description

We are seeking a data-minded, detail-oriented Appeals & Grievances (A&G) Analyst to monitor, analyze, and optimize our health plan complaint, grievance, and appeal operations. In this remote role, you will be the bridge between operational casework and analytical reporting supporting our Texas fully insured Individual & Family Plan (IFP/Marketplace) and large group (25+ employees) commercial products.

The A&G Analyst is responsible for:

• Tracking regulatory Turnaround Times (TAT)
• Identifying operational bottlenecks
• Conducting root-cause trend analyses on member complaints
• Preparing audit universes
• Ensuring reporting integrity across administrative platforms

Direct familiarity with health plan data and workflows is strongly preferred.

Qualifications

• Bachelor’s degree in Healthcare Analytics, Health Information Management, Business, Statistics, Public Health, or a related field (or equivalent operational healthcare experience)
• Minimum of 3–5 years of managed care or health plan experience, with at least 2 years focused on Appeals & Grievances, compliance reporting, or healthcare complaint analytics
• Proven understanding of Commercial health insurance structures, including Large Group and Individual & Family Plans (ACA/Marketplace)
• Solid understanding of state and federal A&G reporting requirements, complaint taxonomies, and statutory TAT standards

Requirements

• Experience with AxisCore platform, querying, extracting data from, or navigating modules (claims processing, customer service/call center tracking, or complaint management)
• Experience generating and validating formal audit universes for CMS, DOI, or NCQA reviews
• Advanced Excel/Sheets skills; experience creating dashboards and querying relational databases
• Background in developing reporting solutions to replace manual tracking logs

Benefits

• Fully remote work environment
• Competitive salary and benefits package
• Generous PTO
• 10 paid holidays
• Medical, Dental, and Vision Insurance
• 401(k) Investment Plan
• Professional development and growth opportunities
• A transparent and unique culture
• Collaborative and dynamic work environment

Company Description

At Harbor Health, we're transforming healthcare in Texas through collaboration and innovation. We're seeking passionate individuals to help us create a member-centered experience that connects comprehensive care with a modern payment model. If you're ready to make a meaningful impact in a dynamic environment where your contributions are valued, please bring your talents to our team!