[Hiring] Paralegal - Grievance and Appeals Claims Analyst @Arthur Grand Technologies Inc

Role Description

The Grievance and Appeals (G&A) Claims Analyst is responsible for the end-to-end processing of appeals, grievances, and medical claim disputes received from members, providers, and regulatory agencies. This is a high-level analytical role that requires "thinking on your feet" to resolve a backlog of medical claim cases.

• Conduct deep-dive research into internal/external resources.
• Review contracts and apply complex rules to determine if a claim is acceptable.
• Facilitate managerial-level conferences and negotiate resolutions.
• Document every step of the process.
• Communicate final decisions via formal written correspondence that meets strict corporate and regulatory accuracy guidelines.

Qualifications

• High-Level Analytical & Logical Mindset: Ability to examine facts and contextual information to make confident, assertive, and persuasive decisions.
• Advanced Claims Expertise: Proven experience reading, analyzing, and reviewing claims at a high level. FACETS or NASCO experience is a significant advantage.
• Superior Communication: Outstanding verbal skills for conferences and expert-level writing skills for formal documentation.
• Research & Logic: Ability to interpret contracts, apply policies/procedures, and structure thorough, logic-based responses.
• Fast-Paced Delivery: Comfortable managing tight deadlines and high-quality standards in a remote environment.
• Technical Proficiency: Strong PC skills, including the MS Office Suite and the ability to navigate multiple complex databases simultaneously.
• Confidentiality: High regard for protecting member, employee, and corporate information.
• Professional Background: Previous experience in a concierge or high-end customer service setting (beyond standard CSR roles).

Requirements

• Legal Background: Experience working in a legal setting, paralegal experience, or contract review is a major plus.
• Subject Matter Expertise: Background in research and formal writing.
• Bachelor’s Degree Required. Preferred Majors: English/Writing, Health Care Administration, History, Juris Doctorate (JD), Paralegal Studies, or Political Science.

Benefits

• Market-relevant benefits.
• Opportunities for professional growth.