Paralegal Grievance and Appeals Claims Analyst

Romulus, MI - USA

Monthly Salary: Not Disclosed

Posted on: 4 hours ago

Vacancies: 1 Vacancy

Job Summary

Title of Position: Paralegal - Grievance and Appeals Claims Analyst

Location: Remote (Preferred Michigan location candidates)

Duration: Long Term

Employment: Contract

Rate: $Negotiable

Job Description:

Engagement 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.

The Analyst will conduct deep-dive research into internal/external resources review contracts and apply complex rules to determine if a claim is acceptable. You will facilitate managerial-level conferences negotiate resolutions and document every step of the process. Final decisions must be communicated via formal written correspondence that meets strict corporate and regulatory accuracy guidelines.

Top Required Skills & Experience

High-Level Analytical & Logical Mindset: Ability to examine facts and contextual information to make confident assertive and persuasive decisions. Must be a strong negotiator capable of professional back-and-forth to reach a resolution.
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 (mastery of grammar spelling and punctuation is non-negotiable).

Additional Required Skills

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).

Preferred Qualifications

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.

Education Requirements

Bachelors Degree Required. * Preferred Majors: English/Writing Health Care Administration History Juris Doctorate (JD) Paralegal Studies or Political Science.

About Arthur Grand

Arthur Grand is an IT services firm specializing in Digital Transformation initiatives for Federal Commercial State & local customers. Since 2012 Arthur Grand has been successfully supporting and delivering IT services to our customers in the areas of enterprise modernization and transformation with a core focus on emerging technologies including Cloud Solutions (AWS Azure) Agile Development Custom Programming Full Stack Development DevOps DevSecOps CI/CD Web Development Mobile APP Development Data Visualization Data Warehousing Financial/ERP System Implementation and Infrastructure Management. Arthur Grands culture of delivery excellence combined with a commitment to bring the best talent to provide services has earned our company an unparalleled reputation for delivering transformative results.

We are a minority-owned staff augmentation and technology consulting company

To keep our valued employees we need to keep them engaged in challenging interesting work offer market-relevant benefits and provide continued opportunities for professional growth. Please send your resume for immediate consideration

If you are interested in the above opportunity we warmly invite you to join our team.

Arthur Grand Technologies is an Equal Opportunity Employer (including disability/vets)

Additional Information :

All your information will be kept confidential according to EEO guidelines.

Remote Work :

Yes

Employment Type :

Contract

Title of Position: Paralegal - Grievance and Appeals Claims AnalystLocation: Remote (Preferred Michigan location candidates)Duration: Long Term Employment: ContractRate: $Negotiable Job Description:Engagement DescriptionThe Grievance and Appeals (G&A) Claims Analyst is responsible for the end-to-en...