[Hiring] Grievance & Appeals Analyst @Alliance

Role Description

The Grievance and Appeals Analyst responds to grievances and appeals to ensure the resolutions are consistent with organizational policies and procedures and compliant with state and federal guidelines. The Analyst synthesizes and analyzes all available data, which may contain multiple issues and require coordination of responses from multiple business units. Responsibilities include:

• Ensuring timely, customer-focused responses to complaints and appeals.
• Identifying trends and emerging issues, reporting and recommending solutions.
• Working with internal and external customers to gather and verify information related to consumer safety and provider compliance.
• Identifying critical issues and triaging them appropriately to ensure urgent member needs are met expediently.
• Communicating trends and actionable analysis to appropriate parties in a timely manner.

This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to the home office (Morrisville, NC) for onsite team meetings as needed. Must have the flexibility to work weekends and holidays to fit the business needs.

Qualifications

• A minimum of a Bachelor’s degree from an accredited college or university with a major in mental health, public health, psychology, sociology, public administration, management information systems, statistics, or a related field.
• A minimum of two years working in human services/behavioral health post bachelor’s degree and/or a minimum of two years of experience analyzing data sets, interpreting and synthesizing data into a report format, and working with teams/units to integrate data information needs.

Requirements

• Knowledge of Federal and State regulations on Behavioral Healthcare grievances and appeals processes.
• Knowledge of medical records practices and records keeping practices.
• Knowledge of legal proceedings including mediation, administrative law courts, and other legal processes.
• Demonstrated proficiency in personal computer use and MS Excel.
• Some familiarity with other software packages, such as SPSS and MS Word, Project, Publisher, PowerPoint, and BI is desired.
• Good oral, written, and graphic presentation skills.
• Understanding of data analysis and techniques.
• Ability to integrate programmatic information into required data sets for analysis and interpretation.
• Ability to work well with others in a fast-paced, and sometimes stressful, environment.
• Experience with customer service, provider relations, or similar activities is preferred.
• Experience working with individuals with mental health, substance abuse issues, and/or intellectual disabilities preferred.

Benefits

• Medical, Dental, Vision, Life, Long Term Disability.
• Generous retirement savings plan.
• Flexible work schedules including hybrid/remote options.
• Paid time off including vacation, sick leave, holiday, management leave.
• Dress flexibility.

Salary Range

$61,439-$79,871/Annually. Exact compensation will be determined based on the candidate's education, experience, external market data, and consideration of internal equity.