Appeals Analyst

    • Contract
  • Hamilton, NJ
  • 22-26/hr

Remote opportunity after 1st week of training in Hamilton NJ

This is a contract to hire opportunity. Conversion salary 50k-60k

This position is responsible for handling denied insurance claims. Working with medical providers to come to a resolution..

  • Responsible for the end to end process for appeals, including but not limited to the receipt of appeals, data entry into medical management system, facilitating external review by vendors, and timely case completion.
  • Speak to providers and members regarding the appeal process, as well as status of appeals.
  • Answer and triage the appeal Hotline phone queue.
  • Collaborate with both internal and external vendors to ensure that appeals are processed maintaining NCQA, DOBI, State and all other regulatory standards.
  • Update authorizations based on outcome of appeals and ensure that claims are effectuated timely.
  • Collaborate with internal customers to ensure that they are notified of the Appeal outcome.
  • Perform testing and projects to meet departmental goals.


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